Compliance with antimicrobials de-escalation in septic patients and mortality rates

an old subject revisited

Authors

  • Jamal Wadi Al Ramahi M.D, FIDSA Office 11, The Medical Center, Jordan Hospital and medical Center. 29 Adeeb Wahbeh StreetAmman - Jordan 11118
  • Omran Abu Khalaf
  • Lamya Abu Shanab
  • Mohammad Obaidat Pharm
  • Maha Al Hasan
  • Mohammed Mhanna
  • Maha Hashim Abdulghani

DOI:

https://doi.org/10.3823/836

Keywords:

an old subject revisited, Broad-spectrum antimicrobials, bacterial resistance, mortality with de-escalation, antimicrobials stewardship

Abstract

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

Author Biography

Jamal Wadi Al Ramahi M.D, FIDSA, Office 11, The Medical Center, Jordan Hospital and medical Center. 29 Adeeb Wahbeh StreetAmman - Jordan 11118

Adjunct, Assistant Professor of Infectious Diseases, School of Medicine. University of Jordan

Chairman, The Infection Prevention and Control Committee. Al Khalidi Hospital and Medical Center.

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2019-09-15

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