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.
Antimicrob Steward Healthc Epidemiol. 2025 Jun 23;5(1):e135. doi: 10.1017/ash.2025.10054. eCollection 2025.
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.
Prospective observational study.
611-bed, quaternary care academic medical center in the United States.
126 critically ill adults (mean age 68.1 ± 15.6 yr, 51.6% male, median APACHE II score 20.5 [IQR 15-25]); 71.4% met sepsis criteria.
Secondary infection was defined as ≥3 consecutive antibiotic days within a year after the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, BMI, and glucocorticosteroid dose. Time-to-event analysis employed Cox proportional hazards modeling; cumulative infection burden was assessed via nonparametric tests using normalized antibiotic exposure (AD as a proportion of days alive).
Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days ( < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, = 0.739) or readmission (OR 1.01, = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes ( = 0.0033), with higher exposure among patients experiencing two or more secondary infections ( = 0.026 and = 0.036, respectively). Cox regression showed a significant association between AD and time to first secondary infection (HR 1.10, 95% CI: 1.04-1.15, = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.
Extended AD, in critically ill patients, prolongs hospitalization without reducing mortality or readmission rates. These findings highlight the importance of robust antibiotic stewardship practices, where shorter, targeted regimens may minimize unintended complications.
评估抗生素使用时长（AD）和一年无抗生素天数（AFD）是否与危重症成年患者的关键院内及出院后结局相关。
前瞻性观察性研究。
美国一家拥有611张床位的四级医疗学术医学中心。
126例危重症成年患者（平均年龄68.1±15.6岁，51.6%为男性，APACHE II评分中位数为20.5[四分位间距15 - 25]）；71.4%符合脓毒症标准。
继发性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、体重指数和糖皮质激素剂量进行了校正。生存时间分析采用Cox比例风险模型；通过使用标准化抗生素暴露（AD占存活天数的比例）的非参数检验评估累积感染负担。
在30天内，AD越长与住院时间延长相关；在调整后的线性回归中，每增加一天抗生素使用，住院天数增加约0.93天（P<0.001）。AD不能预测一年死亡率（OR = 1.01，P = 0.739）或再入院率（OR = 1.01，P = 0.771）。标准化抗生素暴露因累积继发性感染发作次数而异（P = 0.0033），在经历两次或更多次继发性感染的患者中暴露更高（分别为P = 0.026和P = 0.036）。Cox回归显示AD与首次继发性感染时间之间存在显著关联（HR = 1.10，95%CI：1.04 - 1.15，P = 0.001），表明AD越长越易发生继发性感染或反复使用抗生素。
在危重症患者中，延长AD会延长住院时间，而不会降低死亡率或再入院率。这些发现凸显了强有力的抗生素管理措施的重要性，采用更短、更有针对性的治疗方案可能会将意外并发症降至最低。
