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Open Forum Infect Dis. 2017 Dec 19;5(2):ofx270. doi: 10.1093/ofid/ofx270. eCollection 2018 Feb.

Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit.

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Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan.
Department of Health Care Quality and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts.



The potential adverse effects of empiric broad-spectrum antimicrobial use among patients with suspected but subsequently excluded infection have not been fully characterized. We sought novel methods to quantify the risk of adverse effects of broad-spectrum antimicrobial exposure among patients admitted to an intensive care unit (ICU).


Among all adult patients admitted to ICUs at a single institution, we selected patients with negative blood cultures who also received ≥1 broad-spectrum antimicrobials. Broad-spectrum antimicrobials were categorized in ≥1 of 5 categories based on their spectrum of activity against potential pathogens. We performed, in serial, 5 cohort studies to measure the effect of each broad-spectrum category on patient outcomes. Exposed patients were defined as those receiving a specific category of broad-spectrum antimicrobial; nonexposed were all other patients in the cohort. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay and nosocomial acquisition of antimicrobial-resistant bacteria (ARB) or Clostridium difficile within 30 days of admission.


Among the study cohort of 1918 patients, 316 (16.5%) died within 30 days, 821 (42.8%) had either a length of hospital stay >7 days or an ICU length of stay >3 days, and 106 (5.5%) acquired either a nosocomial ARB or C. difficile. The short-term use of broad-spectrum antimicrobials in any of the defined broad-spectrum categories was not significantly associated with either primary or secondary outcomes.


The prompt and brief empiric use of defined categories of broad-spectrum antimicrobials could not be associated with additional patient harm.


antibiotic stewardship; antimicrobials; broad-spectrum; intensive care unit; nosocomial

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