The length-of-stay associated with adequacy of empirical antimicrobial therapy – systematic reviews with meta-analysis

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 appropriate versus inappropriate 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 hospitalized 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. Results : Thirteen studies with a total of 4,572 participants met the inclusion criteria. The mean LOS for patients receiving appropriate therapy was significantly lower than for those receiving inadequate therapy (mean difference -2.07 days; 95% CI: -2.20, -1.95). This reduction in LOS was consistent across different infection sites, including bloodstream infections, sepsis, and intra-abdominal infections. Sensitivity analysis excluding a dominant study still showed a significant reduction in LOS. Additionally, appropriate 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 hospitalized patients with infections. Early intervention and rapid microbiological diagnosis, especially for multidrug-resistant pathogens, are crucial to optimizing therapy. These findings support the integration of antimicrobial stewardship programs and rapid diagnostic tools to improve patient outcomes and reduce healthcare burdens.