Relationship between antibiotic use and short-term risk of mortality in patients with sepsis-associated encephalopathy: a study based on the medical information mart for intensive care database.

BACKGROUND

In critically ill sepsis patients the use of certain antibiotics can be associated with adverse effects. This study investigates the relationship between the use of different classes of antibiotic during the intensive care unit stay and the 30-day mortality risk in patients with sepsis-associated encephalopathy.

METHODS

This retrospective observational study collected data from the Medical Information Mart for Intensive Care IV database between 2008 and 2019. The antibiotic classes assessed included cephalosporins, penicillins, carbapenems, quinolones, macrolides, and metronidazole. The Cox proportional hazards model was employed to assess the association between the use of different classes of antibiotic and mortality risk in patients with sepsis-associated encephalopathy.

RESULTS

The 30-day mortality was 16.19% (643 out of 3974 patients). The use of penicillins (hazard ratio: 1.32, 95% confidence interval: 1.11-1.58, P = 0.002), macrolides (hazard ratio: 1.50, 95% confidence interval: 1.13-2.00, P = 0.005), and metronidazole (hazard ratio: 1.32, 95% confidence interval: 1.11-1.57, P = 0.002) were associated with a higher risk of 30-day mortality. The use of one, two, or more than three antibiotic classes were associated with an increased risk of 30-day mortality (all P < 0.05). In sepsis-associated encephalopathy patients aged ≥ 65 years, with Sequential Organ Failure Assessment scores ≥ 6, Charlson comorbidity index scores ≥ 2, Glasgow Coma Scale ≥ 8, experiencing acute kidney injury, and receiving opiates or propofol, the number of administered antibiotic classes was significantly associated with increased 30-day mortality risk.

CONCLUSION

We found an association between penicillins, macrolides, and metronidazole usage and 30-day mortality in sepsis-associated encephalopathy patients that needs future prospective randomized control trials to establish causal relationship.