Impact of adequacy of empirical antimicrobial therapy on hospital length of stay: a systematic review and meta-analysis

Abstract

Introduction: Infections, particularly sepsis, require rapid initiation of empirical antibiotic therapy. Delays or inadequacies in therapy can significantly increase patient morbidity, mortality and length of stay (LOS). This systematic review and meta-analysis aimed to evaluate the impact of adequate versus inadequate empirical antibiotic therapy on LOS.

Methods: A comprehensive search was conducted in EMBASE, Cochrane Library, Web of Science and MEDLINE for studies published between 2012 and 2024. Studies involving adult hospitalised patients with infections, assessment of antimicrobial adequacy based on microbiological cultures and LOS data were included. Statistical analysis was performed using Review Manager 5.3, with LOS treated as a continuous variable and outcomes assessed through mean difference and 95% confidence intervals (CIs).

Results: Thirteen studies with a total of 4158 participants met the inclusion criteria. The mean LOS for patients receiving adequate therapy was significantly lower than for those receiving inadequate therapy (mean difference -1.17 days; 95% CI: -1.40, -0.94). When pooling data from all included studies and weighting by sample size, the overall mean LOS for patients receiving adequate empirical antimicrobial therapy was 12.5 days, compared to 28.5 days among those receiving inadequate therapy. Additionally, adequate therapy resulted in a reduced ICU LOS by -0.89 days (95% CI: -1.22, -0.57).

Conclusion: Adequate antimicrobial therapy significantly reduces LOS in hospitalised patients with infections.

Keywords: Antimicrobial stewardship; antimicrobial resistance; eHealth; mHealth; pharmacotherapeutic algorithms; rapid diagnostic methods.