EARLY EMPIRIC BROAD-SPECTRUM ANTIBIOTICS VS. TARGETED ANTIBIOTICS AFTER CULTURE RESULTS IN NECROTISING SOFT TISSUE INFECTIONS: IMPACT ON 14-DAY CLINICAL DETERIORATION

Abstract

Necrotizing soft tissue infections (NSTIs) are life-threatening and rapidly progressive diseases that need immediate medical attention. This randomized controlled trial was prospective in nature and sought to evaluate the efficacy of early empiric broad-spectrum antibiotic therapy versus culture-guided targeted therapy in the prevention of clinical deterioration among NSTI patients. Carried out in the Department of General Surgery of Saveetha Medical College and Hospital, the study recruited 56 adult patients with proven NSTIs, randomly divided into two equal groups. Group A was given early empiric broad-spectrum antibiotics, whereas Group B was given targeted therapy according to culture sensitivity, started with a narrow-spectrum empiric regimen. Clinical worsening within 14 days was the main outcome, and secondary outcomes were time to clinical stabilization, length of stay in the hospital, mortality, and cost of healthcare. The results indicated that the targeted therapy group had significantly less clinical worsening (25.0% vs. 60.7%, p=0.0075), ICU admissions, organ failure, and sepsis advancement. They also showed faster clinical recovery, shorter hospital stays (10.3 vs. 14.6 days, p=0.0002), lower rates of ventilator support (7.1% vs. 28.6%, p=0.0373), and lower treatment costs. Mortality rates at 30 days and readmission were less in the targeted group but were not significantly different. This study concludes that culture-guided targeted antibiotic therapy is superior to empiric early therapy in promoting clinical improvement and decreasing the burden of care on healthcare systems in the management of NSTI.