Antibiotic modification versus withhold in febrile patients without evidence of bacterial infection, unresponsive to initial empiric regimen: a multicentre retrospective study conducted in Israel

This study compared outcomes of modifying, withholding, or continuing the same antibiotic regimen for such patients. Febrile or hypothermic stable patients with suspected infection, unresponsive to empiric antibiotic treatment, admitted to one of 15 internal medicine departments in three hospitals during a 5-year study period, were included. Patients with a definitive clinical or microbiological bacterial infection, malignancy, immunodeficiency, altered mental status, or need for mechanical ventilation were excluded. Participants were divided into groups based on treatment strategy determined 72  h after antibiotic initiation: antibiotic modified, withheld or continued. Outcomes measured included in-hospital and 30-day post-discharge-mortality rates, length of hospital stay (LOS) and days of antimicrobial therapy (DOT). A total of 486 patients met the inclusion criteria: 124 in theAntibiotic modified group, 67 in theAntibiotic withheld group and 295 in theInitial antibiotic continued group. Patient characteristics were similar among groups with no differences in mortality rates in-hospital (23% vs. 25% vs. 20%,p = 0.58) and within 30 days after discharge (5% vs. 3% vs. 4%,p = 0.83). Changing antibiotics led to longer LOS (9.0 ± 6.8 vs. 6.2 ± 5.6 days,p = 0.003) and more DOT (8.6 ± 6.0 vs. 3.2 ± 1.0 days,p <  0.001) compared to withholding treatment. Withholding as compared to modifying antibiotics, in febrile patients with no clear evi...
Source: European Journal of Clinical Microbiology and Infectious Diseases - Category: Microbiology Source Type: research