A RECENT study found that de-escalating β-lactam (BL) antibiotics in hospitalized sepsis patients significantly reduced the risk of developing new Gram-negative antibiotic resistance, which suggests a promising strategy for combating the rise of antibiotic-resistant bacteria in clinical settings.
The retrospective cohort study analysed data from patients with sepsis who received at least three consecutive days of BL antibiotics, with the first two days involving a broad-spectrum BL agent. Patients were categorized into three groups based on changes in their BL spectrum score (BLSS): de-escalation, no change, or escalation. Patients with sepsis were enrolled in the study if they had been treated with beta-lactam antibiotics for at least three consecutive days, of which the first two days we treated with a BL agent with a spectrum score of ≥7. The study tracked the incidence of new drug-resistant Gram-negative bacteria within 60 days. The primary outcome was measured using Fine-Gray proportional hazards regression modeling, accounting for in-hospital death as a competing risk.
Results showed that out of 7,742 patients, 644 (8.3%) developed new Gram-negative resistance, with a mean time to resistance of 23.7 days. The incidence rate of new resistance was 1.85 per 1,000 patient days. Notably, the de-escalation group exhibited the lowest incidence rate of 1.42 per 1,000 patient days. Patients in the de-escalation group had a statistically significant reduction in the risk of developing new Gram-negative resistance compared to those with no change in their beta-lactam spectrum score (hazard ratio 0.59).
This study was the largest of its kind and highlights the effectiveness of BL de-escalation in reducing the risk of new antibiotic resistance in patients with sepsis. Implementing de-escalation strategies could be a new crucial step in preventing the spread of resistant bacteria in hospitals, improving patient outcomes, and preserving the efficacy of existing antibiotics. Which is extremely important in the current era of antibiotic resistance.
Aleksandra Zurowska, EMJ
Reference:
Teshome BF et al. Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study. Clin Infect Dis. 2024:ciae253.
