Infect Drug Resist. 2014 Jun 27;7:177-82. doi: 10.2147/IDR.S65928. eCollection 2014.
Safety and feasibility of antibiotic de-escalation in bacteremic pneumonia.
Infection and drug resistance
Faisal A Khasawneh, Adnanul Karim, Tashfeen Mahmood, Subhan Ahmed, Sayyed F Jaffri, Mansoor Mehmood
Affiliations
Affiliations
- Section of Infectious Diseases, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
- Department of Internal Medicine, Deaconess Hospital, Evansville, IN, USA.
- Section of Nephrology, Department of Internal Medicine, University of Oklahoma, Tulsa, OK, USA.
PMID: 25061323
PMCID: PMC4085320 DOI: 10.2147/IDR.S65928
Abstract
BACKGROUND: Antibiotic 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.
METHODS: A 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.
RESULTS: Sixty-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.
CONCLUSION: Antibiotic 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.
Keywords: antibiotic de-escalation strategy; bacteremia; lung infection
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