Burrows Parker, Brown Ruth-Ann, Samuelsen Abigail, Bonavia Anthony S
Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17036, USA.
Institut de Genetique et de Biologie Moleculaire et Cellulaire, Cedex, France.
medRxiv. 2025 Mar 25:2025.03.24.25324548. doi: 10.1101/2025.03.24.25324548.
To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.
Retrospective observational study.
Quaternary care academic medical center in the United States.
A total of 126 critically ill adults, mean age 68.1 years (±15.6), 51.6% male, median APACHE II score of 20.5 (IQR 15-25); 71.4% met sepsis criteria.
Patient demographics, clinical characteristics, antibiotic use, and outcomes were collected over one year. Secondary infection was defined as ≥3 consecutive antibiotic days within a year following the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, gender, and glucocorticosteroid dose.
Within 30 days, longer AD correlated with increased hospital stay (p<0.001) with each additional day of antibiotics associated with 0.37 - 0.39 extra days of hospitalization in univariate and multivariate analyses, respectively. In septic patients specifically, AFD significantly correlated with hospital length-of-stay in both univariate (p=0.023) and multivariate analyses (p=0.002), with no impact from infection type on AD or AFD. Fewer AFD correlated with higher secondary bacteremia rates in unadjusted analysis (p=0.023 overall), but this effect was not significant after multivariable adjustment. Neither AD nor AFD predicted one-year mortality or readmission.
Extended antibiotic duration in critically ill patients prolonged hospital stays without providing mortality or readmission benefits. These findings underscore the importance of robust antibiotic stewardship, where shorter, targeted regimens can reduce unintended complications and improve overall outcomes.
评估抗生素使用时长（AD）和一年无抗生素天数（AFD）与危重症成年患者关键的院内及出院后结局之间的关联。
回顾性观察研究。
美国的四级医疗学术医学中心。
共126例危重症成年患者，平均年龄68.1岁（±15.6），男性占51.6%，急性生理与慢性健康状况评分系统（APACHE II）中位数为20.5（四分位间距15 - 25）；71.4%符合脓毒症标准。
收集患者一年的人口统计学资料、临床特征、抗生素使用情况及结局。二次感染定义为在首次脓毒症入院后一年内连续使用抗生素≥3天。多变量分析对年龄、APACHE II评分、性别和糖皮质激素剂量进行了校正。
在30天内，AD越长与住院时间延长相关（p<0.001），在单变量和多变量分析中，每增加一天抗生素使用分别与额外0.37 - 0.39天的住院时间相关。具体在脓毒症患者中，AFD在单变量（p=0.023）和多变量分析（p=0.002）中均与住院时长显著相关，感染类型对AD或AFD无影响。在未校正分析中，AFD越少与较高的继发性菌血症发生率相关（总体p=0.023），但多变量校正后该效应不显著。AD和AFD均不能预测一年死亡率或再入院率。
危重症患者延长抗生素使用时长会延长住院时间，且未带来死亡率或再入院方面的益处。这些发现强调了强有力的抗生素管理的重要性，即采用更短、更有针对性的治疗方案可减少意外并发症并改善总体结局。
