When to De-Escalate Broad-Spectrum Antibiotics in Sepsis

Although early empiric broad-spectrum antibiotic therapy is an important part of sepsis management, it has been associated with adverse events such as Clostridioides difficile infection and antimicrobial resistance. To examine the safety of early antibiotic de-escalation, researchers studied a cohort of adults in Michigan hospitals who were started on broad-spectrum antibiotic therapy for community-acquired infections and were still on it at day 3.

Using statistical methods to mimic a clinical trial, researchers compared 3000 patients who were de-escalated from anti–methicillin-resistant Staphylococcus aureus (MRSA) coverage on day 4 with 4000 patients who continued such coverage; patients who had MRSA identified by day 3 were exclude…