ABSTRACT
Importance: 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. Objective: To describe trends in empiric broad-spectrum antibiotic use for suspected community-onset sepsis. Design, Setting, and Participants: 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. Exposures: Empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) and/or antipseudomonal ß-lactam agent use. Main Outcomes and Measures: Annual rates of empiric anti-MRSA and/or antipseudomonal ß-lactam agent use and the proportion that were likely unnecessary in retrospect based on the absence of ß-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. Results: Among 6â¯272â¯538 hospitalizations (median [IQR] age, 66 [53-78] years; 443â¯465 male [49.6%]; 106â¯095 Black [11.9%], 65â¯763 Hispanic [7.4%], 653â¯907 White [73.1%]), 894â¯724 (14.3%) had suspected community-onset sepsis, of whom 582â¯585 (65.1%) received either empiric anti-MRSA (379â¯987 [42.5%]) or antipseudomonal ß-lactam therapy (513â¯811 [57.4%]); 311â¯213 (34.8%) received both. Patients with suspected community-onset sepsis accounted for 1â¯573â¯673 of 3â¯141â¯300 (50.1%) of total inpatient anti-MRSA antibiotic days and 2â¯569â¯518 of 5â¯211â¯745 (49.3%) of total antipseudomonal ß-lactam days. Between 2017 and 2021, the proportion of patients with suspected sepsis administered anti-MRSA or antipseudomonal therapy increased from 63.0% (82â¯731 of 131â¯275 patients) to 66.7% (101â¯003 of 151â¯435 patients) (adjusted OR [aOR] per year, 1.03; 95% CI, 1.03-1.04). However, resistant organisms were isolated in only 65â¯434 cases (7.3%) (30â¯617 gram-positive [3.4%], 38â¯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 (527â¯356 of 582â¯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). Conclusions and Relevance: 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.