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The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis

BACKGROUND/AIMS: Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture-negative pneumonia. METHODS: We performed a systematic review...

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Autores principales: Song, Jae-Uk, Lee, Jonghoo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Internal Medicine 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493446/
https://www.ncbi.nlm.nih.gov/pubmed/37586813
http://dx.doi.org/10.3904/kjim.2023.115
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author Song, Jae-Uk
Lee, Jonghoo
author_facet Song, Jae-Uk
Lee, Jonghoo
author_sort Song, Jae-Uk
collection PubMed
description BACKGROUND/AIMS: Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture-negative pneumonia. METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. The primary outcome was inpatient mortality. RESULTS: We examined six studies comprising 11,933 subjects, of whom 1,152 received ADE. Overall, the ADE strategy was associated with a statistically lower risk of in-hospital mortality compared with non-ADE (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.93). Although substantial heterogeneity was found among the included studies (I(2) = 66%), a meta-regression analysis could not reveal plausible sources of heterogeneity. And ADE was associated with a shorter duration of total and initial antibiotic therapies and total length of hospital stay compared with non-ADE. CONCLUSIONS: Our findings suggest that ADE seems to be significantly associated with better clinical outcomes compared with non-ADE. Caution is demanded when interpreting data of this study because of substantial between-study heterogeneity.
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spelling pubmed-104934462023-09-12 The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis Song, Jae-Uk Lee, Jonghoo Korean J Intern Med Original Article BACKGROUND/AIMS: Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture-negative pneumonia. METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. The primary outcome was inpatient mortality. RESULTS: We examined six studies comprising 11,933 subjects, of whom 1,152 received ADE. Overall, the ADE strategy was associated with a statistically lower risk of in-hospital mortality compared with non-ADE (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.93). Although substantial heterogeneity was found among the included studies (I(2) = 66%), a meta-regression analysis could not reveal plausible sources of heterogeneity. And ADE was associated with a shorter duration of total and initial antibiotic therapies and total length of hospital stay compared with non-ADE. CONCLUSIONS: Our findings suggest that ADE seems to be significantly associated with better clinical outcomes compared with non-ADE. Caution is demanded when interpreting data of this study because of substantial between-study heterogeneity. Korean Association of Internal Medicine 2023-09 2023-08-17 /pmc/articles/PMC10493446/ /pubmed/37586813 http://dx.doi.org/10.3904/kjim.2023.115 Text en Copyright © 2023 The Korean Association of Internal Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Song, Jae-Uk
Lee, Jonghoo
The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title_full The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title_fullStr The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title_full_unstemmed The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title_short The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
title_sort impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493446/
https://www.ncbi.nlm.nih.gov/pubmed/37586813
http://dx.doi.org/10.3904/kjim.2023.115
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