{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:26:13Z","timestamp":1792448773632,"version":"4.5.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec id=\"ab-ioi250083-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Prolonged exposure to broad-spectrum antibiotics (BSA) may be associated with patient harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess outcomes of BSA de-escalation compared with continuation on encounter day 4 in patients hospitalized for community-onset sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This target trial emulation study was conducted at 67 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Patients 18 years and older hospitalized for community-onset sepsis from June 2020 through September 2024 who initiated empiric BSA therapy without evidence of multidrug-resistant organism infection were included. Data were analyzed from September 2024 to November 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Inverse probability of treatment\u2013weighted cohort exposed to de-escalation of BSA vs continuation at day 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was 90-day all-cause mortality. Secondary outcomes included in-hospital mortality, 30-day mortality, length of hospitalization, and days of antibiotic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 36\u202f924 patients with community-onset sepsis, 18\u202f559 (50.3%) were female, 18\u202f365 (49.7%) were male, and the median (IQR) age was 71 (61-80) years. A total of 6926 (18.8%) and 11\u202f149 (30.2%) were eligible for target trial emulations evaluating de-escalation of anti\u2013methicillin-resistant\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (MRSA) and anti\u2013\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      (PSA; or other resistant gram-negative bacteria) antibiotics, respectively. Of these, 2993 (43.2%) and 2493 (22.4%) were de-escalated from anti-MRSA and anti-PSA coverage. After weighting, patients who were de-escalated vs continued on BSA were well balanced on baseline characteristics. In weighted analyses, anti-MRSA and anti-PSA de-escalation were associated with similar 90-day mortality as continued BSA therapy (anti-MRSA: odds ratio, 1.00; 95% CI, 0.88-1.14; anti-PSA: odds ratio, 0.98; 95% CI, 0.86-1.13). Additionally, anti-MRSA and anti-PSA de-escalation were associated with fewer days of antibiotics to day 14 (anti-MRSA de-escalation: risk ratio [RR], 0.91; 95% CI, 0.89-0.93; anti-PSA de-escalation: RR, 0.91; 95% CI, 0.88-0.93) and shorter length of hospitalization (anti-MRSA de-escalation: RR, 0.88; 95% CI, 0.85-0.92; anti-PSA de-escalation: RR, 0.91; 0.88-0.93). All other secondary outcomes were similar. Across 67 hospitals, the proportion of eligible patients de-escalated from BSA varied more than 2-fold (anti-MRSA de-escalation, 27.3% to 61.7%; anti-PSA de-escalation, 6.9% to 37.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250083-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, de-escalation of empiric BSA therapy at day 4 was associated with similar safety outcomes, fewer antibiotic days, and shorter length of hospitalization among patients with community-onset sepsis compared with those who continued BSA therapy but varied widely in practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.6919","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:31:07Z","timestamp":1766421067000},"page":"192","source":"Crossref","is-referenced-by-count":16,"title":["Antibiotic De-Escalation in 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