Discontinuation of Glycopeptides in Patients with Culture Negative Severe Sepsis or Septic Shock: A Propensity-Matched Retrospective Cohort Study

Abstract

Implementation of antibiotic stewardship is difficult in patients with sepsis because of severity of disease. We evaluated the impact of glycopeptide discontinuation (GD) in patients with culture negative severe sepsis or septic shock who received glycopeptides as initial empiric antibiotic therapy at admission. We conducted a single center retrospective cohort study between January 2010 and March 2018. GD was defined as discontinuation of initial empiric glycopeptides on availability of culture results, revealing the absence of identified pathogens. In 92 included patients, the leading causes of sepsis were pneumonia (34.8%) and intra-abdominal infection (23.9%); 28-day mortality and overall mortality were 14% and 21%, respectively. Glycopeptides were discontinued in 42/92 patients. After propensity score matching, baseline characteristics were not significantly different between the GD and non-GD (GND) groups. GND was associated with development of acute kidney injury (OR 5.54, 95% CI 1.49–20.6, P = 0.011). GD did not increase the 7-day, 14-day, and 28-day mortality compared with GND. The length of hospital stay was shorter in the GD group than in GND group (16.33 ± 17.11 vs. 25.05 ± 14.37, P = 0.082), though not statistically significant. GD may be safe and reduce adverse events of prolonged antibiotic use in patients with culture negative severe sepsis or septic shock receiving glycopeptides as initial empiric antibiotic therapy.

Impacto del seguimiento de la recomendación de un programa de optimización de antiinfecciosos (PROA) sobre la prescripción de meropenem en la Clínica Universidad de Navarra.

“…de re-escalar cuando desescaló empíricamente desde un antiinfeccioso de amplio espectro a una quinolona en pacientes con cultivos negativos. En otro estudio, Kim y cols(114) evaluaron en pacientes con sepsis o shock séptico con cultivos negativos el impacto de la retirada de la cobertura frente a grampositivos (glicopéptido). Para ello realizaron un estudio de cohortes con 2 grupos, uno en el que suspendieron el glicopéptido tras la ausencia de aislamiento microbiológico y otro grupo en el que lo riesgo de desarrollar una infección por el mismo microorganismo por el cual un paciente esta colonizado es controvertido, no obstante, cada vez hay más trabajos que apuntan a una posible relación.…”