Document Detail


De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients.
MedLine Citation:
PMID:  21509424     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to examine the safety and efficacy of de-escalating antimicrobial therapy in immunocompetent patients presenting with bacteraemia due to antibiotic-sensitive pathogens.
METHODS: We screened 1,350 positive blood cultures identified in a single, 1,065-bed university hospital over 5 years, and retained 310 cases of bacteraemia due to antibiotic-sensitive pathogens, including (1) methicillin-sensitive staphylococci, (2) penicillin-sensitive streptococci, (3) β-lactam-sensitive (a) Escherichia coli, and (b) Klebsiella species. The efficacy of appropriate initial empirical antimicrobial therapy, the performance of de-escalated pathogen-directed therapy, and the safety and efficacy of de-escalated therapy were evaluated.
RESULTS: Among 270 appropriately treated patients, 16 (6%) died, versus 6 (15%) among 40 who were inappropriately treated (p = 0.04). While 201 of 270 patients (74%) who received appropriate initial empirical therapy were candidates for de-escalation, the treatment was de-escalated in only 79 (39%). De-escalation was associated with (1) a trend toward a lower (a) death rate (1 vs. 5%) and (b) treatment failure (4 vs. 10%), and (2) (a) a 4-day longer median duration and (b) a $50 higher median cost of antimicrobial therapy (p < 0.001).
CONCLUSIONS: When the pathogen was sensitive to antimicrobial therapy and the initial empirical treatment was effective, de-escalation of antimicrobial therapy in immunocompetent patients with bacteraemia was safe and associated with acceptable outcomes. The rate of de-escalation of antimicrobial therapy was low.
Authors:
N Shime; S Satake; N Fujita
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-21
Journal Detail:
Title:  Infection     Volume:  39     ISSN:  1439-0973     ISO Abbreviation:  Infection     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-09-01     Completed Date:  2011-12-21     Revised Date:  2012-06-13    
Medline Journal Info:
Nlm Unique ID:  0365307     Medline TA:  Infection     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  319-25     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. shime@koto.kpu-m.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Algorithms
Anti-Bacterial Agents / therapeutic use*
Bacteremia / drug therapy*,  immunology*,  mortality
Critical Care / methods*
Decision Trees
Enterobacteriaceae / drug effects
Enterobacteriaceae Infections / drug therapy,  microbiology,  mortality
Female
Gram-Positive Bacteria / drug effects
Gram-Positive Bacterial Infections / drug therapy*,  immunology*,  mortality
Humans
Immunocompromised Host*
Japan
Male
Middle Aged
Penicillins / therapeutic use
Retrospective Studies
Time Factors
Treatment Outcome
beta-Lactams / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Penicillins; 0/beta-Lactams
Comments/Corrections
Comment In:
Infection. 2012 Apr;40(2):223-4   [PMID:  22090318 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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