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Compliance with antimicrobials de-escalation in septic patients and mortality rates
Author(s) -
Fidsa Jamal Wadi Al Ramahi,
Omran Abu Khalaf,
Lamya Abu Shanab,
Mohammad Obaidat Pharm,
Maha Al Hasan,
Mohammed Mhanna,
Maha Hashim Abdulghani
Publication year - 2019
Publication title -
the international arabic journal of antimicrobial agents
Language(s) - English
Resource type - Journals
ISSN - 2174-9094
DOI - 10.3823/836
Subject(s) - medicine , de escalation , antimicrobial , logistic regression , sepsis , medical diagnosis , emergency medicine , mortality rate , critically ill , intensive care medicine , chemistry , organic chemistry , pathology
Background To compare the recent de-escalations rates with a six-year earlier study, and mortality associated with de-escalation. Methods Settings A prospective multicenter study including septic patients, all were on broad-spectrum antimicrobials (BSA). Excluded from the study patients on antimicrobial prophylaxis, and patients without a microbiological diagnosis, or bacteria were solely BSA-susceptible. The study team made recommendations for antimicrobials de-escalation to the treating physician(s) must an opportunity loomed. Results 182 patients were available for analysis. De-escalation was achieved in 43 (24%) patients. The clinical diagnoses, comorbidities, commonly used antimicrobials, the microbiological diagnoses were not different between the two groups (patients with and without de-escalation). Logistic regression analysis showed no correlation between bacterial species and de-escalation (Nagelkerke R2 = 0.076). Relapsing sepsis and reinfection were not different (P > 0.05). The in-hospital mortality rates for the de-escalated patients were lower (P = 0.015), not on day 30 (P = 0.354). The length of the ICU stay and ward stay were not different (P >0.05), but more de-escalated patients were discharged home from the ICU (P = 0.034), however, patients without de-escalation were discharged more from the ward (P = 0.002).    Conclusion De-escalation rates increased within six years from 6.7% - 24% (P = 0.000), with added benefits of shorter ICU stay and less in-hospital mortality

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