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Dynamic treatment regime in critical ill patients with high risk of antibiotic drug resistance, a cohort study

Liu, Y.

2025-01-24 epidemiology
10.1101/2025.01.22.25320993 medRxiv
Show abstract

Antibiotic resistance threatens modern medicine, especially in critical care. This retrospective observational cohort study, based on MIMIC-IV v2.0 database, included 2,532 ICU admissions with high - risk antibiotic resistance. We aimed to find the optimal strategy for using high - risk resisted antibiotics in critical ill patients by constructing a dynamic treatment regime (DTR) model with DWSurv method. The results showed that the DTR optimal models suggestion differed from clinical practice. Clinical practice showed a sharp decline in high - risk resistance antibiotic administration, while the model suggested treatment with gaps in 7 days. Survival analysis indicated that the DTR model had a lower mortality rate. The more the clinical practice disobeyed the models recommendation, the higher the 28 - day mortality (adjusted HR = 1.21, 95%CI: 1.12 - 1.30, P<0.001). This study suggests that the DTR model might offer a new perspective on personalized antibiotic administration, but its clinical application remains to be further explored.

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