Written by Jason Lesnick
This retrospective study found 1 in 3 patients who received broad spectrum antibiotics in the ED likely did not have a bacterial infection and one in six had antibiotic-related complications.
The retrospectoscope strikes again!
Sepsis metrics place an immense amount of pressure on emergency physicians to give broad spectrum antibiotics rapidly or risk CMS decreasing reimbursement to the hospital. There is resistance against these ‘SEP-1’ guidelines, as they have not been demonstrated to decrease mortality.
This study attempted to quantify the frequency of antibiotic overtreatment and associated harms in ED patients treated for suspected sepsis. The authors conducted a retrospective cohort study of 600 adults across 7 U.S. EDs from 2019-2022 who received anti-MRSA and/or antipseudomonal β-lactam antibiotics.
The definitions used for inappropriate and unnecessarily broad coverage are interesting. Antibiotic adequacy and efficacy were determined based on antibiotic susceptibilities if a causative organism was cultured, but also involved reviewers’ subjective interpretation of possible causes, if none were confirmed.
The authors claim that in retrospect, 325/411 (79.1%) of patients received antibiotics that were unnecessarily broad. They also state that 61/256 (23.8%) of patients with a causative organism identified required coverage broader than ceftriaxone. They report possible antibiotic-associated complications occurred in 104/600 (17.3%) of patients within 90 days, most commonly new infection or colonization with organisms resistant to first-line treatments (48/600, 8.0%).
How will this change my practice?
I hope future studies on antibiotic utilization will help come up with rapid ways to identify who does not need broad spectrum antibiotics reliably in real time. For now, my practice won’t change, based on the intense pressure exerted by CMS to make hospitals comply with these guidelines.
Source
Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study. Clin Infect Dis. 2025 Apr 15:ciaf118. doi: 10.1093/cid/ciaf118. Epub ahead of print. PMID: 40231968.
