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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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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. |
format | Online Article Text |
id | pubmed-10303525 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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