Close-up on a sick senior adult being visited at the hospital by his son - healthcare and medicine
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A new report finds that de-escalation of antibiotics is uncommon among patients with sepsis, a serious condition that occurs often in older adults.
In a Dec. 6 report that was published in Clinical Infectious Diseases, researchers examined data on 124,577 patients thought to have sepsis who were admitted to 236 United States hospitals between 2017 and 2021.
The people were treated with two or more days of a nti–methicillin-resistant Staphylococcus aureus (MRSA) or anti-pseudomonal antibiotics, but didn’t have resistant organisms requiring the medications. Of participants, 29.5% stopped the broad-spectrum antibiotics or switched to another antibiotic by the fourth day. Researchers defined de-escalation as stopping anti-MRSA and anti-pseudomonal antibiotics or switching to narrower antibiotics by day four.
According to official sepsis guidelines, people must start treatment quickly with broad-spectrum antibiotics and reassess using the medication within 48 to 72 hours, the authors noted. De-escalation is associated with reduced risk of adverse outcomes.
The highest de-escalation rates were found in large hospitals and teaching hospitals in urban areas and the Northeast.
In an unrelated sepsis study published Monday in JAMA, researchers found that measuring procalcitonin (PCT) reduces antibiotic duration safely compared with standard care or using the C-reactive protein (CRP) biomarkers.
The study was on 2,760 adults in 41 UK intensive care units who received intravenous antibiotics for suspected sepsis. People had blood drawn and followed three different protocols for assessing antibiotic discontinuation: standard care, care guided by PCT or care led by CRP protocol.
The PCT-guided protocol reduced the amount of time people were on antibiotics. The team didn’t note a difference in how long people were on antibiotics in those in the CRP group compared to those given standard care.
According to the Sepsis Alliance, older adults who are aged 65 years and older are 13 times more likely to be hospitalized with sepsis compared to those who are younger. Also, 63% of older adults over the age of 60 who visit an intensive care unit have sepsis when they’re admitted.