The relation between prescribing of different antibiotics and rates of mortality with sepsis in US adults

BMC Infect Dis. 2020 Feb 22;20(1):169. doi: 10.1186/s12879-020-4901-7.


Background: Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality.

Methods: We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions.

Results: Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups.

Conclusions: Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.

Keywords: Antibiotics; Mortality; Penicillins; Sepsis.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Death Certificates
  • Drug Prescriptions*
  • Female
  • Humans
  • Insurance, Health
  • Male
  • Middle Aged
  • Penicillin Resistance
  • Penicillins / administration & dosage
  • Penicillins / adverse effects
  • Penicillins / therapeutic use*
  • Prevalence
  • Sepsis / drug therapy
  • Sepsis / epidemiology*
  • Sepsis / mortality*
  • United States / epidemiology
  • Young Adult


  • Anti-Bacterial Agents
  • Penicillins