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Objective <p>Although inappropriate therapy has been consistently associated with adverse outcomes, the magnitude and consistency of the benefit associated with appropriate empiric therapy in critically ill patients remain uncertain. We aimed to quantify the prevalence of appropriate empiric antimicrobial therapy and evaluate its association with outcomes and antimicrobial exposure in a large international ICU cohort.</p> Methods <p>This predefined sub-analysis of the DIANA study included adult ICU patients receiving empirical antimicrobials for suspected or confirmed bacterial infection. Only patients with microbiologically confirmed infections were analyzed, and therapy was classified as appropriate if at least one agent demonstrated in vitro activity against the identified pathogen. Associations with 28-day mortality and antimicrobial-free days were assessed using multivariable logistic and Cox regression models. Pre-specified interaction analyses explored effect modification by disease severity and diagnostic certainty.</p> Results <p>Of 845 patients with microbiologically confirmed infections, 87.7% received appropriate empirical antimicrobial therapy. Compared with inappropriate therapy, appropriate therapy was associated with significantly lower ICU mortality and longer 28-day antimicrobial-free days and mechanical ventilation-free days. After multivariable adjustment, appropriate therapy remained independently associated with reduced 28-day mortality [adjusted odds ratio (OR) 1.83, 95% confidence interval 1.11–3.06, p = 0.02; hazard ratio (HR) 1.51, 95% CI 1.03–2.21, p = 0.035]. Effect-modification analyses demonstrated that the survival benefit of appropriate therapy was consistent across levels of diagnostic certainty and was most pronounced in patients with moderate illness severity (SOFA 3–9).</p> Conclusion <p>In critically ill ICU patients, appropriate empirical antimicrobial therapy is independently associated with reduced 28-day mortality rates.</p> Visual abstract <p></p>

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Impact of appropriate antimicrobial therapy on patient outcomes and antimicrobial use: a sub analysis of the DIANA Study Dataset

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • José Pedro Cidade,
  • Pedro Póvoa,
  • Pieter Depuydt,
  • Sofie Dhaese,
  • Ken De Smet,
  • Alexis Tabah,
  • Murat Akova,
  • Menino Osbert Cotta,
  • Gennaro De Pascale,
  • George Dimopoulos,
  • Shigeki Fujitani,
  • Jose Garnacho-Montero,
  • Marc Leone,
  • Jeffrey Lipman,
  • Marlies Ostermann,
  • José-Artur Paiva,
  • Jeroen Schouten,
  • Fredrik Sjövall,
  • Jean-François Timsit,
  • Jason A. Roberts,
  • Jean Ralph Zahar,
  • Farid Zand,
  • Kapil Zirpe,
  • Jan J. De Waele,
  • Liesbet De Bus,
  • Fernando Rios,
  • Alejandro Risso Vazquez,
  • Maria Gabriela Vidal,
  • Graciela Zakalik,
  • Antony George Attokaran,
  • Iouri Banakh,
  • Smita Dey-Chatterjee,
  • Julie Ewan,
  • Janet Ferrier,
  • Loretta Forbes,
  • Cheryl Fourie,
  • Anne Leditschke,
  • Lauren Murray,
  • Philipp Eller,
  • Patrick Biston,
  • Stephanie Bracke,
  • Luc De Crop,
  • Nicolas De Schryver,
  • Eric Frans,
  • Herbert Spapen,
  • Claire Van Malderen,
  • Stijn Vansteelandt,
  • Daisy Vermeiren,
  • Elias Pablo Arévalo,
  • Mónica Crespo,
  • Roberto Zelaya Flores,
  • Petr Píza,
  • Diego Morocho Tutillo,
  • Andreas Elme,
  • Anne Kallaste,
  • Joel Starkopf,
  • Jeremy Bourenne,
  • Mathieu Calypso,
  • Yves Cohen,
  • Claire Dahyot-Fizelier,
  • François Depret,
  • Max Guillot,
  • Nadia Imzi,
  • Sebastien Jochmans,
  • Achille Kouatchet,
  • Alain Lepape,
  • Olivier Martin,
  • Markus Heim,
  • Stefan J. Schaller,
  • Kostoula Arvaniti,
  • Anestis Bekridelis,
  • Panagiotis Ioannidis,
  • Cornelia Mitrakos,
  • Metaxia N. Papanikolaou,
  • Sofia Pouriki,
  • Anna Vemvetsou,
  • Babu Abraham,
  • Pradip Kumar Bhattacharya,
  • Anusha Budugu,
  • Subhal Dixit,
  • Sushma Gurav,
  • Padmaja Kandanuri,
  • Dattatray Arun Prabhu,
  • Darshana Rathod,
  • Kavitha Savaru,
  • Ashwin Neelavar Udupa,
  • Sunitha Binu Varghese,
  • Hossein Haddad Bakhodaei,
  • Gholamreza Dabiri,
  • Mohammad Javad Fallahi,
  • Farnia Feiz,
  • Mohammad Firoozifar,
  • Vahid Khaloo,
  • Behzad Maghsudi,
  • Mansoor Masjedi,
  • Reza Nikandish,
  • Golnar Sabetian,
  • Brian Marsh,
  • Ignacio Martin-Loeches,
  • Jan Steiner,
  • Maria Barbagallo,
  • Anselmo Caricato,
  • Andrea Cortegiani,
  • Rocco D’Andrea,
  • Cristian Deana,
  • Abele Donati,
  • Massimo Girardis,
  • Giuliana Mandalà,
  • Giovanna Panarello,
  • Daniela Pasero,
  • Lorella Pelagalli,
  • Paolo Maurizio Soave,
  • Savino Spadaro,
  • Yoshihito Fujita,
  • Shinsuke Fujiwara,
  • Yuya Hara,
  • Hideki Hashi,
  • Satoru Hashimoto,
  • Hideki Hashimoto,
  • Katsura Hayakawa,
  • Masashi Inoue,
  • Shutaro Isokawa,
  • Shinya Kameda,
  • Hidenobu Kamohara,
  • Masafumi Kanamoto,
  • Shinshu Katayama,
  • Toshiomi Kawagishi,
  • Yasumasa Kawano,
  • Yoshiko Kida,
  • Mami Kita,
  • Atsuko Kobayashi,
  • Akira Kuriyama,
  • Takaki Naito,
  • Hiroshi Nashiki,
  • Kei Nishiyama,
  • Shunsuke Shindo,
  • Taketo Suzuki,
  • Akihiro Takaba,
  • Chie Tanaka,
  • Komuro Tetsuya,
  • Yoshihiro Tomioka,
  • Youichi Yanagawa,
  • Hideki Yoshida,
  • Syamhanin Adnan,
  • Mohd Shahnaz Hasan,
  • Helmi Sulaiman,
  • Gilberto A. Gasca Lopez,
  • Carmen M. Hernández-Cárdenas,
  • Silvio A. Ñamendys-Silva,
  • Carina Bethlehem,
  • Dylan de Lange,
  • Nicole Hunfeld,
  • Sandra Numan,
  • Henk van Leeuwen,
  • Daniel Owens,
  • Mónica Almeida,
  • Elsa Fragoso,
  • Tiago Leonor,
  • José-Manuel Pereira,
  • Daniela Filipescu,
  • Ioana Grigoras,
  • Mihai Popescu,
  • Dana Tomescu,
  • Mohammed S. Alshahrani,
  • Manuel Alvarez-Gonzalez,
  • Irene Barrero-García,
  • Miguel Angel Blasco-Navalpotro,
  • Laura Claverias,
  • Ángel Estella,
  • Lorena Forcelledo Espina,
  • Jose Luis Garcia Garmendia,
  • Emilio García Prieto,
  • Gracia Gómez-Prieto,
  • Carlos Jiménez Conde,
  • Fernando Martinez Sagasti,
  • Alicia Muñoz Cantero,
  • Alberto Orejas-Gallego,
  • Elisabeth Papiol,
  • Demetrio Pérez-Civantos,
  • Juan Carlos Pozo Laderas,
  • Josep Trenado Álvarez,
  • Paula Vera-Artázcoz,
  • Pablo Vidal Cortés,
  • Anders Oldner,
  • Martin Spångfors,
  • Emine Alp,
  • Iftihar Köksal,
  • Volkan Korten,
  • Arife Özveren,
  • Anna Hall,
  • Kevin W. Hatton,
  • Krzysztof Laudanski,
  • Devashish Desai

摘要

Objective

Although inappropriate therapy has been consistently associated with adverse outcomes, the magnitude and consistency of the benefit associated with appropriate empiric therapy in critically ill patients remain uncertain. We aimed to quantify the prevalence of appropriate empiric antimicrobial therapy and evaluate its association with outcomes and antimicrobial exposure in a large international ICU cohort.

Methods

This predefined sub-analysis of the DIANA study included adult ICU patients receiving empirical antimicrobials for suspected or confirmed bacterial infection. Only patients with microbiologically confirmed infections were analyzed, and therapy was classified as appropriate if at least one agent demonstrated in vitro activity against the identified pathogen. Associations with 28-day mortality and antimicrobial-free days were assessed using multivariable logistic and Cox regression models. Pre-specified interaction analyses explored effect modification by disease severity and diagnostic certainty.

Results

Of 845 patients with microbiologically confirmed infections, 87.7% received appropriate empirical antimicrobial therapy. Compared with inappropriate therapy, appropriate therapy was associated with significantly lower ICU mortality and longer 28-day antimicrobial-free days and mechanical ventilation-free days. After multivariable adjustment, appropriate therapy remained independently associated with reduced 28-day mortality [adjusted odds ratio (OR) 1.83, 95% confidence interval 1.11–3.06, p = 0.02; hazard ratio (HR) 1.51, 95% CI 1.03–2.21, p = 0.035]. Effect-modification analyses demonstrated that the survival benefit of appropriate therapy was consistent across levels of diagnostic certainty and was most pronounced in patients with moderate illness severity (SOFA 3–9).

Conclusion

In critically ill ICU patients, appropriate empirical antimicrobial therapy is independently associated with reduced 28-day mortality rates.

Visual abstract