Reviewed by Sara Karaba, MD, PhD, MHS, Johns Hopkins University
Bottom line: A new study indicates that narrowing antibiotic coverage decreases the risk of subsequent resistant Gram negative organisms.
There is new evidence to support the practice of de-escalating antibiotics. Teshome and colleagues retrospectively evaluated 7742 patients with sepsis based on discharge diagnosis codes from 2010-2017 from a single center, and evaluated the beta-lactam spectrum score (BLSS). Based upon the spectrum of (empiric) beta-lactam at cohort entry and the duration of antibiotics, patients were assigned a cumulative BLSS. The patients’ actual BLSS was calculated and patients were grouped in to categories of de-escalation BLSS, no change in BLSS, and escalation of BLSS. 8.3% of patients developed new Gram negative resistance on a subsequent culture within 60 days, with a mean time to resistance of 23.7 days. Statistically significant reductions in the risk of developing new Gram negative resistance was associated with the de-escalation BLSS as compared to no change (HR 0.59, 95% CI 0.48-0.73) in a Fine and Gray competing risk model, but not observed in comparing escalation to de-escalation (HR 0.74, 95% CI 0.46-1.16). in a subgroup analysis, it seems the magnitude risk reduction for development of resistance associated with antibiotic de-escalation may be greatest among patients exposed to beta-lactams for longer durations (>11 days).
Reference:
Teshome BF, Park T, Arackal J, Hampton N, Kollef MH, Micek ST. Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study. Clin Infect Dis 2024; :ciae253.