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Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures

(1) Background: Antibiotics are received by a majority of adult intensive care unit (ICU) patients. Guidelines recommend antibiotic de-escalation (ADE) when culture results are available; however, there is less guidance for patients with negative cultures. The purpose of this study was in investigat...

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Autores principales: Roper, Spencer, Wingler, Mary Joyce B., Cretella, David A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303525/
https://www.ncbi.nlm.nih.gov/pubmed/37368430
http://dx.doi.org/10.3390/pharmacy11030104
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author Roper, Spencer
Wingler, Mary Joyce B.
Cretella, David A.
author_facet Roper, Spencer
Wingler, Mary Joyce B.
Cretella, David A.
author_sort Roper, Spencer
collection PubMed
description (1) Background: Antibiotics are received by a majority of adult intensive care unit (ICU) patients. Guidelines recommend antibiotic de-escalation (ADE) when culture results are available; however, there is less guidance for patients with negative cultures. The purpose of this study was in investigate ADE rates in an ICU population with negative clinical cultures. (2) Methods: This single-center, retrospective, cohort study evaluated ICU patients who received broad-spectrum antibiotics. The definition of de-escalation was antibiotic discontinuation or narrowing of the spectrum within 72 h of initiation. The outcomes evaluated included the rate of antibiotic de-escalation, mortality, rates of antimicrobial escalation, AKI incidence, new hospital acquired infections, and lengths of stay. (3) Results: Of the 173 patients included, 38 (22%) underwent pivotal ADE within 72 h, and 82 (47%) had companion antibiotics de-escalated. Notable differences in patient outcomes included shorter durations of therapy (p = 0.003), length of stay (p < 0.001), and incidence of AKI (p = 0.031) in those that underwent pivotal ADE; no difference in mortality was found. (4) Conclusions: The results from this study show the feasibility of ADE in patients with negative clinical cultures without a negative impact on the outcomes. However, further investigation is needed to determine its effect on the development of resistance and adverse effects.
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spelling pubmed-103035252023-06-29 Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures Roper, Spencer Wingler, Mary Joyce B. Cretella, David A. Pharmacy (Basel) Article (1) Background: Antibiotics are received by a majority of adult intensive care unit (ICU) patients. Guidelines recommend antibiotic de-escalation (ADE) when culture results are available; however, there is less guidance for patients with negative cultures. The purpose of this study was in investigate ADE rates in an ICU population with negative clinical cultures. (2) Methods: This single-center, retrospective, cohort study evaluated ICU patients who received broad-spectrum antibiotics. The definition of de-escalation was antibiotic discontinuation or narrowing of the spectrum within 72 h of initiation. The outcomes evaluated included the rate of antibiotic de-escalation, mortality, rates of antimicrobial escalation, AKI incidence, new hospital acquired infections, and lengths of stay. (3) Results: Of the 173 patients included, 38 (22%) underwent pivotal ADE within 72 h, and 82 (47%) had companion antibiotics de-escalated. Notable differences in patient outcomes included shorter durations of therapy (p = 0.003), length of stay (p < 0.001), and incidence of AKI (p = 0.031) in those that underwent pivotal ADE; no difference in mortality was found. (4) Conclusions: The results from this study show the feasibility of ADE in patients with negative clinical cultures without a negative impact on the outcomes. However, further investigation is needed to determine its effect on the development of resistance and adverse effects. MDPI 2023-06-16 /pmc/articles/PMC10303525/ /pubmed/37368430 http://dx.doi.org/10.3390/pharmacy11030104 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Roper, Spencer
Wingler, Mary Joyce B.
Cretella, David A.
Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title_full Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title_fullStr Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title_full_unstemmed Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title_short Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures
title_sort antibiotic de-escalation in critically ill patients with negative clinical cultures
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303525/
https://www.ncbi.nlm.nih.gov/pubmed/37368430
http://dx.doi.org/10.3390/pharmacy11030104
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