{"doi":"10.1093/cid/ciaf039","title":"Association Between Delayed Broad-Spectrum Gram-negative Antibiotics and Clinical Outcomes: How Much Does Getting It Right With Empiric Antibiotics Matter?","abstract":"BACKGROUND: Clinicians often start unnecessarily broad-spectrum empiric gram-negative antibiotics out of the concern that delaying effective therapy could lead to a worse clinical outcome. This study examined the consequences of delayed initiation of broad-spectrum gram-negative antibiotics. METHODS: In a retrospective cohort of adult inpatients from 928 US hospitals, we compared clinical outcomes after (1) empiric narrow-spectrum antibiotics escalated to broad-spectrum antibiotics (delayed broad-spectrum therapy [DBT]) and (2) empiric broad-spectrum antibiotics continued as post-empiric therapy (early broad-spectrum therapy [EBT]) using Win Ratios. DBT and EBT patients were matched on hospital, admitting diagnosis, and propensity scores incorporating 28 clinical variables. The outcome of interest was a ranked composite of mortality, readmission, and adverse drug events. RESULTS: Out of 746 880 inpatients, 82 276 (11%) received DBT and 664 604 (89.0%) received EBT. Among the 67 046 with DBT who were matched to 67 046 with EBT, mortality was 8.7% after DBT and 9.5% after EBT (P = .022), readmission was 10.5% after DBT and 11.8% after EBT (P < .0001), and the rate of adverse drug events was 8.4% after DBT and 7.2% after EBT (P < .0001). Among matched patients, clinical outcomes were superior after DBT compared with EBT (win-ratio 1.06; P < .0001). CONCLUSIONS: On average, among a large sample of adult inpatients who ultimately received broad-spectrum antibiotic therapy, delaying initiation of a broad-spectrum antibiotic was not associated with worse outcomes. Although broad-spectrum empiric therapy is undoubtedly sometimes warranted, this finding challenges the common belief that is it safer to err towards overly broad-spectrum empiric antibiotic therapy.","journal":"Clinical Infectious Diseases","year":2025,"id":515848,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9405,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":451652,"name":"Katherine E Goodman","orcid":"0000-0003-2851-775X","position":1,"is_corresponding":false},{"id":285334,"name":"Laurence S. Magder","orcid":"0000-0001-9297-1952","position":2,"is_corresponding":false},{"id":649452,"name":"Kimberly C. Claeys","orcid":"0000-0001-6895-604X","position":3,"is_corresponding":false},{"id":1380739,"name":"Mark W. Sutherland","orcid":"0000-0001-5665-6998","position":4,"is_corresponding":false},{"id":381268,"name":"Anthony Harris","orcid":"0000-0001-6270-0481","position":5,"is_corresponding":false},{"id":501753,"name":"Jonathan Baghdadi","orcid":"0000-0002-2442-0654","position":0,"is_corresponding":true}],"reference_count":56,"raw_metadata":null,"created_at":"2026-07-19T02:48:44.647022Z","pmid":"39874272","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}