Safety and feasibility of antibiotic de-escalation in bacteremic pneumonia

Abstract

BackgroundAntibiotic de-escalation is a potential strategy advocated to conserve the effectiveness of broad-spectrum antibiotics. The aim of this study was to examine the safety and feasibility of antibiotic de-escalation in patients admitted with bacteremic pneumonia.MethodsA retrospective chart review was done for patients with bacteremic pneumonia admitted to Northwest Texas Hospital in Amarillo, TX, USA, during 2008. Antibiotic de-escalation was defined as changing the empiric antibiotic regimen to a culture-directed single agent with a narrower spectrum than the original regimen.ResultsSixty-eight patients were admitted with bacteremic pneumonia. Eight patients were not eligible for de-escalation. Among the 60 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 27 cases (45.0%). Discharge to a long-term care facility predicted failure to de-escalate antibiotics, while an infectious diseases consultation was significantly associated with antibiotic de-escalation. The average daily cost of antibacterial therapy in the de-escalation group was $25.7 compared with $61.6 in the group where de-escalation was not implemented. The difference in mean length of hospital stay and mortality between the two groups was not statistically significant.ConclusionAntibiotic de-escalation is a safe management strategy but unfortunately is not widely adopted. Although bacterial resistance poses a significant threat and is rising, antimicrobial de-escalation has emerged as a potential intervention that can conserve the effectiveness of broad-spectrum antibiotics without compromising the patient’s outcome. This practice is becoming important in the face of slow development of new anti-infective agents.

Bacteriology and antibiotic susceptibility of chronic dacryocystitis

“…If the incidence rises further, it may warrant use of newer and expensive antibiotics for empirical therapy to be deescalated after the sensitivity report. (20) Subjecting all the dacryocystitis samples to culture and sensitivity is certainly warranted in this scenario.…”

Are treatment guides and rational drug use policies adequately exploited in combating respiratory system diseases?

“…Previous studies have reported that the current and effective treatment might not always be accessible under financial restrictions, and thus, similar DPP with a lower cost might be selected [12,30,31]. However, maintaining the empiric antibiotic regimen until the end of the treatment has also been reported [30].…”

A Simulation Study Reveals Lack of Pharmacokinetic/Pharmacodynamic Target Attainment in De-escalated Antibiotic Therapy in Critically Ill Patients

“…Of the most recent de-escalation studies, only one has mentioned the dose and mode of administration of the initial broadspectrum regimen, but it did not mention these data about the de-escalated antibiotics (11,(25)(26)(27). Another study mentioned that "the dose and pattern of administration were in accordance with current medical standards" (9).…”

“…The microorganisms used in this simulation study were Escherichia coli, Staphylococcus aureus, Streptococcus spp., Klebsiella pneumoniae, Haemophilus influenzae, Citrobacter freundii, Morganella morganii, and Proteus mirabilis, as these are microorganisms for which de-escalation is more commonly performed (9,11,(25)(26)(27).…”