Association Between In-Hospital Antibiotic Use and Long-Term Outcomes in Critically Ill Patients

To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.

Retrospective observational study.

Quaternary care academic medical center in the United States.

A total of 126 critically ill adults, mean age 68.1 years (±15.6), 51.6% male, median APACHE II score of 20.5 (IQR 15-25); 71.4% met sepsis criteria.

Patient demographics, clinical characteristics, antibiotic use, and outcomes were collected over one year. Secondary infection was defined as ≥3 consecutive antibiotic days within a year following the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, gender, and glucocorticosteroid dose.

Within 30 days, longer AD correlated with increased hospital stay (p<0.001) with each additional day of antibiotics associated with 0.37 - 0.39 extra days of hospitalization in univariate and multivariate analyses, respectively. In septic patients specifically, AFD significantly correlated with hospital length-of-stay in both univariate (p=0.023) and multivariate analyses (p=0.002), with no impact from infection type on AD or AFD. Fewer AFD correlated with higher secondary bacteremia rates in unadjusted analysis (p=0.023 overall), but this effect was not significant after multivariable adjustment. Neither AD nor AFD predicted one-year mortality or readmission.

Extended antibiotic duration in critically ill patients prolonged hospital stays without providing mortality or readmission benefits. These findings underscore the importance of robust antibiotic stewardship, where shorter, targeted regimens can reduce unintended complications and improve overall outcomes.