About half of suspected sepsis cases account for broad-spectrum antibiotic use — but a lot of these cases don’t require the medications at all, according to a study published June 27 in JAMA Network Open.
Of the 6,272,538 people hospitalized, 14.3% were suspected of having sepsis. Resistant organisms were found in 7.3% of sepsis cases; the proportion of people with resistant organisms declined from 9.6% in 2017 to 7.3% in 2021. In total, 90.5% of people suspected of having sepsis who were treated with anti-MRSA and/or antipseudomonal agents didn’t have resistant organisms throughout the study span; that proportion increased from 88% in 2017 to 91.6% in 2021.
Data came from nearly 6.3 million adults admitted to 241 hospitals in the United States between 2017 and 2021. The median age of participants was 66. The main outcomes were annual rates of empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) and/or antipseudomonal beta-lactam antibiotic use — two types of broad-spectrum antibiotics used to treat sepsis.
“These results suggest that more attention is needed toward balancing early broad-spectrum antibiotic prescribing for patients with sepsis with limiting overuse for the majority who do not have antibiotic-resistant infections,” the authors wrote.
People suspected of having sepsis made up 50.1% of total inpatient anti-MRSA antibiotic days and 49.3% of total antipseudomonal beta-lactam days. Those who received anti-MRSA or antipseudomonal therapy were more likely to be severely ill compared to those who didn’t get the medication.
During the course of the study, the number of people getting anti-MRSA or antipseudomonal agents increased from 63% to 66.7%. The increase was mostly in antipseudomonal beta-lactam use, which went up from 54.4% in 2017 to 59.6% in 2021.The findings shouldn’t be taken as being critical of prescribing standards, because the Centers for Medicare and Medicaid Services recommends broad-spectrum antibiotics within three hours of sepsis starting, among other guidelines, the authors noted. Doctors often have to make treatment decisions without enough information, which causes them to err on the side of caution especially when people are severely ill.
