■对于疑似败血症导致医院广谱抗生素使用的程度知之甚少,回顾过去,抗生素疗程的比例不必要地广泛,以及这些模式是否随着时间的推移而改变。
■描述疑似社区型败血症的经验性广谱抗生素使用趋势。
■这项横断面研究使用了PINCAI医疗保健数据库中241家美国医院收治的成年人的临床数据。符合条件的参与者年龄在18岁或以上,在2017年至2021年期间因怀疑社区发作性败血症而入院。由血液培养物抽取定义,乳酸测量,入院时静脉注射抗生素。
■经验性抗耐甲氧西林金黄色葡萄球菌(MRSA)和/或抗假单胞菌β-内酰胺剂的使用。
■经验性抗MRSA和/或抗假单胞菌β-内酰胺药物的使用年率以及根据从医院第4天获得的临床培养物中不存在β-内酰胺抗性革兰氏阳性或头孢曲松抗性革兰氏阴性病原体的情况,回想起来可能不必要的比例。使用混合效应逻辑回归模型计算年度趋势,适应病人和医院的特点。
■在6272538例住院患者中(中位[IQR]年龄,66[53-78]岁;443465名男性[49.6%];106095名黑人[11.9%],65763西班牙裔[7.4%],653907白色[73.1%]),894724(14.3%)疑似社区型败血症,其中582585例(65.1%)接受经验性抗MRSA(379987[42.5%])或抗假单胞菌β-内酰胺治疗(513811[57.4%]);311213例(34.8%)同时接受.疑似社区发作的败血症患者占住院抗MRSA抗生素总天数的1573673,占3141300(50.1%),占5211745的2569518(49.3%)。在2017年至2021年之间,可疑脓毒症患者接受抗MRSA或抗伪粒子治疗的比例从63.0%(131275例患者中的82731例)增加到66.7%(151435例患者中的101003例)(调整后的OR[aOR]每年,1.03;95%CI,1.03-1.04)。然而,只有65434例(7.3%)(30617例革兰阳性[3.4%],38844革兰氏阴性[4.3%]),并且具有任何耐药菌的患者比例从9.6%下降到7.3%(每年的aOR,0.87;95%CI,0.87-0.88)。大多数接受经验性抗MRSA和/或抗假单胞菌治疗的疑似脓毒症患者没有耐药菌(582585例患者中的527356例[90.5%]);这一比例从2017年的88.0%增加到2021年的91.6%(每年aOR,1.12;95%CI,1.11-1.13)。
■在这项针对美国241家医院收治的成年人的横断面研究中,对于疑似社区发作的脓毒症,经验性广谱抗生素的使用占所有抗MRSA或抗假单胞菌治疗的一半;尽管在接受广谱药物治疗的患者中,只有不到10%分离出耐药菌,但在2017年至2021年间,这些类型抗生素的使用有所增加.
UNASSIGNED: Little is known about the degree to which suspected sepsis drives broad-spectrum antibiotic use in hospitals, what proportion of antibiotic courses are unnecessarily broad in retrospect, and whether these patterns are changing over time.
UNASSIGNED: To describe trends in empiric broad-spectrum antibiotic use for suspected community-onset sepsis.
UNASSIGNED: This cross-sectional study used clinical data from adults admitted to 241 US hospitals in the PINC AI Healthcare Database. Eligible participants were aged 18 years or more and were admitted between 2017 and 2021 with suspected community-onset sepsis, defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration on admission.
UNASSIGNED: Empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) and/or antipseudomonal β-lactam agent use.
UNASSIGNED: Annual rates of empiric anti-MRSA and/or antipseudomonal β-lactam agent use and the proportion that were likely unnecessary in retrospect based on the absence of β-lactam resistant gram-positive or ceftriaxone-resistant gram-negative pathogens from clinical cultures obtained through hospital day 4. Annual trends were calculated using mixed-effects logistic regression models, adjusting for patient and hospital characteristics.
UNASSIGNED: Among 6 272 538 hospitalizations (median [IQR] age, 66 [53-78] years; 443 465 male [49.6%]; 106 095 Black [11.9%], 65 763 Hispanic [7.4%], 653 907 White [73.1%]), 894 724 (14.3%) had suspected community-onset sepsis, of whom 582 585 (65.1%) received either empiric anti-MRSA (379 987 [42.5%]) or antipseudomonal β-lactam therapy (513 811 [57.4%]); 311 213 (34.8%) received both. Patients with suspected community-onset sepsis accounted for 1 573 673 of 3 141 300 (50.1%) of total inpatient anti-MRSA antibiotic days and 2 569 518 of 5 211 745 (49.3%) of total antipseudomonal β-lactam days. Between 2017 and 2021, the proportion of patients with suspected sepsis administered anti-MRSA or antipseudomonal therapy increased from 63.0% (82 731 of 131 275 patients) to 66.7% (101 003 of 151 435 patients) (adjusted OR [aOR] per year, 1.03; 95% CI, 1.03-1.04). However, resistant organisms were isolated in only 65 434 cases (7.3%) (30 617 gram-positive [3.4%], 38 844 gram-negative [4.3%]) and the proportion of patients who had any resistant organism decreased from 9.6% to 7.3% (aOR per year, 0.87; 95% CI, 0.87-0.88). Most patients with suspected sepsis treated with empiric anti-MRSA and/or antipseudomonal therapy had no resistant organisms (527 356 of 582 585 patients [90.5%]); this proportion increased from 88.0% in 2017 to 91.6% in 2021 (aOR per year, 1.12; 95% CI, 1.11-1.13).
UNASSIGNED: In this cross-sectional study of adults admitted to 241 US hospitals, empiric broad-spectrum antibiotic use for suspected community-onset sepsis accounted for half of all anti-MRSA or antipseudomonal therapy; the use of these types of antibiotics increased between 2017 and 2021 despite resistant organisms being isolated in less than 10% of patients treated with broad-spectrum agents.