Clin Infect Dis

Delayed broad-spectrum antibiotics not linked to worse outcomes

April 30, 2025

Study details: This retrospective cohort study analyzed data from 746,880 adult inpatients across 928 U.S. hospitals to compare clinical outcomes between delayed broad-spectrum therapy (DBT) and early broad-spectrum therapy (EBT). Patients were matched based on hospital, admitting diagnosis, and propensity scores incorporating 28 clinical variables.

Results: Of 746,880 inpatients, 11% received DBT and 89% received EBT. In matched groups (67,046 each), mortality was 8.7% for DBT vs. 9.5% for EBT (p = 0.022), readmission was 10.5% for DBT vs. 11.8% for EBT (p<0.0001), and adverse drug events were 8.4% for DBT vs. 7.2% for EBT (p<0.0001). Clinical outcomes were better with DBT (win-ratio 1.06; p<0.0001).

Clinical impact: The findings challenge the prevailing belief that early broad-spectrum empiric antibiotic therapy is safer. Delaying broad-spectrum antibiotics didn’t lead to worse outcomes, suggesting that clinicians can prioritize antibiotic stewardship without compromising patient care.

Source:

Baghdadi JD, et al. (2025, January 28). Clin Infect Dis. Association between Delayed Broad-Spectrum Gram-negative Antibiotics and Clinical Outcomes: How Much Does Getting It Right with Empiric Antibiotics Matter? https://pubmed.ncbi.nlm.nih.gov/39874272/