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1
In the DIANA sub-analysis of 845 critically ill patients with confirmed infections, appropriate empirical therapy was independently associated with improved survival (adjusted odds ratio, 1.83).
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2
Appropriate empirical therapy in DIANA was also associated with more antimicrobial-free days and more mechanical ventilation-free days.
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3
Survival gains in DIANA were most evident among patients with moderate illness severity (SOFA score, 3-9); this finding is hypothesis-generating, not proof of a ceiling effect.
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4
Appropriateness encompasses in vitro activity, infection site, host immune status, source control, dosing strategy, and time to treatment.
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5
The authors caution that appropriate therapy should not mean maximal broad-spectrum coverage, which can cause collateral harm, including increased mortality and microbiome depletion.
