25 Dec 2025 • Broad-spectrum antibiotic de-escalation by day 4 was safe and reduced antibiotic exposure in patients with community-onset sepsis compared with continued use.

Nearly 37,000 hospitalized adults received empiric broad-spectrum therapy without evidence of multidrug-resistant infection. Early de-escalation of anti-methicillin-resistant Staphylococcus aureus or anti-Pseudomonas aeruginosa coverage did not raise 90-day mortality and was similar to continued use (OR 0.98-1.00). De-escalation was linked to fewer antibiotic days by day 14 (RR 0.91 for both) and shorter hospital stays (RR 0.88-0.91). In-hospital mortality and 30-day mortality were similar between both groups. De-escalation practices varied more than two-fold across US hospitals.

The findings support early antibiotic de-escalation as a safe, effective stewardship strategy in appropriately selected patients with community-onset sepsis.

Source: JAMA Network | Read full story