Prescribing antibiotics for febrile patients without proof of bacterial infection contributes to antimicrobial resistance. Lack of clinical response in these patients often leads to antibiotic escalation, although data supporting this strategy are scarce. This study compared outcomes of modifying, withholding, or continuing the same antibiotic regimen for such patients. Febrile or hypothermic stable patients with suspected infection, unresponsive to empiric antibiotic treatment, admitted to one of 15 internal medicine departments in three hospitals during a 5-year study period, were included. Patients with a definitive clinical or microbiological bacterial infection, malignancy, immunodeficiency, altered mental status, or need for mechanical ventilation were excluded. Participants were divided into groups based on treatment strategy determined 72 h after antibiotic initiation: antibiotic modified, withheld or continued. Outcomes measured included in-hospital and 30-day post-discharge-mortality rates, length of hospital stay (LOS) and days of antimicrobial therapy (DOT). A total of 486 patients met the inclusion criteria: 124 in the Antibiotic modified group, 67 in the Antibiotic withheld group and 295 in the Initial antibiotic continued group. Patient characteristics were similar among groups with no differences in mortality rates in-hospital (23% vs. 25% vs. 20%, p = 0.58) and within 30 days after discharge (5% vs. 3% vs. 4%, p = 0.83). Changing antibiotics led to longer LOS (9.0 ± 6.8 vs. 6.2 ± 5.6 days, p = 0.003) and more DOT (8.6 ± 6.0 vs. 3.2 ± 1.0 days, p < 0.001) compared to withholding treatment. Withholding as compared to modifying antibiotics, in febrile patients with no clear evidence of bacterial infection, is a safe strategy associated with decreased LOS and DOT.

在没有细菌感染证据的情况下，为高热患者开处方抗生素会增加抗药性。尽管缺乏支持这种策略的数据，但这些患者缺乏临床反应通常会导致抗生素升级。这项研究比较了针对此类患者修改，停用或继续使用相同抗生素方案的结果。纳入了在5年的研究期间进入三家医院的15个内科部门之一的，怀疑感染的发热或低温稳定患者，对经验性抗生素治疗无反应。排除具有明确临床或微生物细菌感染，恶性肿瘤，免疫缺陷，精神状态改变或需要机械通气的患者。根据开始抗生素治疗72小时后确定的治疗策略将参与者分为几类：抗生素改良，保留或继续治疗。评估的结果包括医院内和出院后30天死亡率，住院时间（LOS）和抗微生物治疗天数（DOT）。共有486例患者符合纳入标准：其中124例符合抗生素修饰组，抗生素禁忌组中的67个和初始抗生素继续组中的295个。各组之间的患者特征相似，院内死亡率（23％vs. 25％vs. 20％，p  = 0.58）无差异，出院后30天内（5％vs. 3％vs. 4％，p  = 0.83）。 与扣留治疗相比，更换抗生素导致更长的LOS（9.0±6.8 vs. 6.2±5.6天，p  = 0.003）和更多的DOT（8.6±6.0 vs. 3.2±1.0天，p <0.001）。在没有明确细菌感染证据的高热患者中，与改良抗生素相比，扣留是与降低LOS和DOT相关的安全策略。