Τίτλος:
De-escalation of antimicrobial therapy in ICU settings with high prevalence of multidrug-resistant bacteria: A multicentre prospective observational cohort study in patients with sepsis or septic shock
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: De-escalation of empirical antimicrobial therapy, a key component of antibiotic stewardship, is considered difficult in ICUs with high rates of antimicrobial resistance. Objectives: To assess the feasibility and the impact of antimicrobial de-escalation in ICUs with high rates of antimicrobial resistance. Methods: Multicentre, prospective, observational study in septic patients with documented infections. Patients in whom de-escalation was applied were compared with patients without de-escalation by the use of a propensity score matching by SOFA score on the day of de-escalation initiation. Results: A total of 262 patients (mean age 62.2 ± 15.1 years) were included. Antibiotic-resistant pathogens comprised 62.9%, classified as MDR (12.5%), extensively drug-resistant (49%) and pandrug-resistant (1.2%). In 97 (37%) patients de-escalation was judged not feasible in view of the antibiotic susceptibility results. Of the remaining 165 patients, judged as patients with de-escalation possibility, de-escalation was applied in 60 (22.9%). These were matched to an equal number of patients without de-escalation. In this subset of 120 patients, de-escalation compared with no de-escalation was associated with lower all-cause 28 day mortality (13.3% versus 36.7%, OR 0.27, 95% CI 0.11-0.66, P = 0.006); ICU and hospital mortality were also lower. De-escalation was associated with a subsequent collateral decrease in the SOFA score. Cox multivariate regression analysis revealed de-escalation as a significant factor for 28 day survival (HR 0.31, 95% CI 0.14-0.70, P = 0.005). Conclusions: In ICUs with high levels of antimicrobial resistance, feasibility of antimicrobial de-escalation was limited because of the multi-resistant pathogens isolated. However, when de-escalation was feasible and applied, it was associated with lower mortality. © The Author(s) 2020.
Συγγραφείς:
Routsi, C.
Gkoufa, A.
Arvaniti, K.
Kokkoris, S.
Tourtoglou, A.
Theodorou, V.
Vemvetsou, A.
Kassianidis, G.
Amerikanou, A.
Paramythiotou, E.
Potamianou, E.
Ntorlis, K.
Kanavou, A.
Nakos, G.
Hassou, E.
Antoniadou, H.
Karaiskos, I.
Prekates, A.
Armaganidis, A.
Pnevmatikos, I.
Kyprianou, M.
Zakynthinos, S.
Poulakou, G.
Giamarellou, H.
Περιοδικό:
Journal of Antimicrobial Chemotherapy (JAC)
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
aminoglycoside; antibiotic agent; carbapenem; cephalosporin; colistin; glycopeptide; linezolid; piperacillin plus tazobactam; quinolone derivative; tigecycline; antiinfective agent, Acinetobacter baumannii; adult; all cause mortality; antibiotic resistance; antibiotic sensitivity; antimicrobial therapy; Article; Candida; clinical outcome; cohort analysis; controlled study; critically ill patient; drug withdrawal; Enterococcus; Escherichia coli; female; hospital mortality; human; intensive care unit; Klebsiella pneumoniae; major clinical study; male; middle aged; multicenter study; multidrug resistant bacterium; observational study; prospective study; Pseudomonas aeruginosa; sepsis; septic shock; Sequential Organ Failure Assessment Score; Staphylococcus aureus; superinfection; treatment duration; aged; bacterium; clinical trial; intensive care unit; prevalence, Aged; Anti-Bacterial Agents; Bacteria; Humans; Intensive Care Units; Middle Aged; Prevalence; Prospective Studies; Sepsis; Shock, Septic
