Antibiotic De-escalation and 30-day mortality in patients with suspected bacterial culture-negative Sepsis.

PURPOSE: The implementation of early antibiotic de-escalation and its outcomes among patients with suspected bacterial culture-negative sepsis remain poorly characterized. The objective of this study was to evaluate whether antibiotic de-escalation was associated with 30-day mortality while accounting for early changes in severity of illness. METHODS: We conducted a retrospective cohort study of adult patients with community-onset sepsis and negative bacterial cultures using Duke Health System data between 2016 and 2023. Sepsis was defined using the CDC Adult Sepsis Event criteria. Antibiotic change was assessed within 5 days of onset. De-escalation was defined as a reduction in antibiotic rank across 4 spectrum-based categories, discontinuation of anti-MRSA antibiotics, or reduction in the number of antibiotics. The cohort was stratified by SOFA score change from day 1 to day 3 as SOFA-improved (≤ - 2), SOFA-unchanged (-1 to 1), or SOFA-deteriorated (≥ + 2). RESULTS: A total of 7741 patients met the inclusion criteria; 33% showed improved SOFA scores, 59% had unchanged scores, and 8% had worsened scores. Overall, antibiotic de-escalation occurred in 4806 patients (62%). The crude 30-day mortality rate was 17%. In multivariable regression analyses, antibiotic de-escalation was not associated with 30-day mortality (adjusted OR 0.92; 95% CI 0.79-1.07). Findings were similar across SOFA change strata. CONCLUSION: Approximately two thirds of patients with suspected bacterial culture-negative sepsis underwent antibiotic de-escalation, suggesting potential opportunities to optimize antimicrobial stewardship. Antibiotic de-escalation was not associated with increased 30-day mortality across SOFA change groups.

Duke Scholars

Author Rebekah Moehring Medicine, Infectious Diseases

Author Vijay Krishnamoorthy Anesthesiology, Critical Care Medicine

Author Tetsu Ohnuma Anesthesiology, Critical Care Medicine

Author Miriam Treggiari Anesthesiology, Critical Care Medicine