Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Impact of withholding early antibiotic therapy in nonseptic surgical patients with suspected nosocomial infection: a retrospective cohort analysis

Estevão Bassi, Bruno Martins Tomazini, Bárbara Vieira Carneiro, Amanda Rodrigues de Oliveira Siqueira, Sara Rodrigues de Oliveira Siqueira, Thais Guimarães, Fernando da Costa Ferreira Novo, Edivaldo Massazo Utiyama, Paolo Pelosi, Luiz Marcelo Sá Malbouisson

Downloads: 0
Views: 395



Systemic inflammatory responses mimicking infectious complications are often present in surgical patients.


The objective was to assess the association between withholding early antimicrobial therapy while investigating alternative diagnoses and worse outcomes in nonseptic patients with suspected nosocomial infection in a retrospective cohort of critically ill surgical patients. The initiation of antibiotic therapy within 24h of the suspicion of infection was defined as the Early Empirical Antibiotic strategy (EEA) group and the initiation after 24h of suspicion or not prescribed was defined as the Conservative Antibiotic strategy (CA) group. Primary outcome was composite: death, sepsis, or septic shock within 14 days. Main exclusion criteria were sepsis or an evident source of infection at inclusion.


Three hundred and forty patients were eligible for inclusion (74% trauma patients). Age, sex, reason for hospital admission, SAPS3 score, SOFA score, and use of vasopressors or mechanical ventilation were not different between the groups. Within 14 days of inclusion, 100% (130/130) of EEA patients received antibiotics compared to 57% (120/210) of CA patients. After adjusting for confounding variables, there was no association between primary outcome and the groups. In a post hoc subgroup analysis including only patients with a posteriori confirmed infection (by microbiological cultures), delay in initiation of adequate antimicrobial therapy was independently associated with the primary outcome (Odds Ratio = 1.19 per day of delay; 95% CI 1.05–1.37).


Withholding early empiric antibiotic therapy was not associated with progression of organ dysfunction within 14 days in nonseptic surgical patients with suspected nosocomial infection without an obvious source.


642ec9e5a95395491d62c253 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections