Cargando…

Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program

BACKGROUND: Expanding antimicrobial resistance patterns in the face of stagnant growth in novel antibiotic production underscores the importance of antibiotic stewardship in which de-escalation remains an integral component. We measured the frequency of antibiotic de-escalation in a tertiary care me...

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Peter, Ohl, Christopher, Johnson, James, Williamson, John, Beardsley, James, Luther, Vera
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153830/
https://www.ncbi.nlm.nih.gov/pubmed/27955625
http://dx.doi.org/10.1186/s12879-016-2080-3
_version_ 1782474773185429504
author Liu, Peter
Ohl, Christopher
Johnson, James
Williamson, John
Beardsley, James
Luther, Vera
author_facet Liu, Peter
Ohl, Christopher
Johnson, James
Williamson, John
Beardsley, James
Luther, Vera
author_sort Liu, Peter
collection PubMed
description BACKGROUND: Expanding antimicrobial resistance patterns in the face of stagnant growth in novel antibiotic production underscores the importance of antibiotic stewardship in which de-escalation remains an integral component. We measured the frequency of antibiotic de-escalation in a tertiary care medical center with an established antimicrobial stewardship program to provide a plausible benchmark for de-escalation. METHODS: A retrospective, observational study was performed by review of randomly selected electronic medical records of 240 patients who received simultaneous piperacillin/tazobactam and vancomycin from January to December 2011 at an 885-bed tertiary care medical center. Patient characteristics including antibiotic regimen, duration and indication, culture results, length of stay, and hospital mortality were evaluated. Antibiotic de-escalation was defined as the use of narrower spectrum antibiotics or the discontinuation of antibiotics after initiation of piperacillin/tazobactam and vancomycin therapy. Subjects dying within 72 h of antibiotic initiation were considered not de-escalated for subsequent analysis and were subtracted from the study population in determining a modified mortality rate. RESULTS: The most commonly documented indications for piperacillin/tazobactam and vancomycin therapy were pneumonia and sepsis. Of the 240 patients studied, 151 (63%) had their antibiotic regimens de-escalated by 72 h. The proportion of patients de-escalated by 96 h with positive vs. negative cultures was similar, 71 and 72%, respectively. Median length of stay was 4 days shorter in de-escalated patients, and the difference in adjusted mortality was not significant (p = 0.82). CONCLUSIONS: The empiric antibiotic regimens of approximately two-thirds of patients were de-escalated by 72 h in an institution with a well-established antimicrobial stewardship program. While this study provides one plausible benchmark for antibiotic de-escalation, further studies, including evaluations of antibiotic appropriateness and patient outcomes, are needed to inform decisions on potential benchmarks for antibiotic de-escalation.
format Online
Article
Text
id pubmed-5153830
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-51538302016-12-20 Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program Liu, Peter Ohl, Christopher Johnson, James Williamson, John Beardsley, James Luther, Vera BMC Infect Dis Research Article BACKGROUND: Expanding antimicrobial resistance patterns in the face of stagnant growth in novel antibiotic production underscores the importance of antibiotic stewardship in which de-escalation remains an integral component. We measured the frequency of antibiotic de-escalation in a tertiary care medical center with an established antimicrobial stewardship program to provide a plausible benchmark for de-escalation. METHODS: A retrospective, observational study was performed by review of randomly selected electronic medical records of 240 patients who received simultaneous piperacillin/tazobactam and vancomycin from January to December 2011 at an 885-bed tertiary care medical center. Patient characteristics including antibiotic regimen, duration and indication, culture results, length of stay, and hospital mortality were evaluated. Antibiotic de-escalation was defined as the use of narrower spectrum antibiotics or the discontinuation of antibiotics after initiation of piperacillin/tazobactam and vancomycin therapy. Subjects dying within 72 h of antibiotic initiation were considered not de-escalated for subsequent analysis and were subtracted from the study population in determining a modified mortality rate. RESULTS: The most commonly documented indications for piperacillin/tazobactam and vancomycin therapy were pneumonia and sepsis. Of the 240 patients studied, 151 (63%) had their antibiotic regimens de-escalated by 72 h. The proportion of patients de-escalated by 96 h with positive vs. negative cultures was similar, 71 and 72%, respectively. Median length of stay was 4 days shorter in de-escalated patients, and the difference in adjusted mortality was not significant (p = 0.82). CONCLUSIONS: The empiric antibiotic regimens of approximately two-thirds of patients were de-escalated by 72 h in an institution with a well-established antimicrobial stewardship program. While this study provides one plausible benchmark for antibiotic de-escalation, further studies, including evaluations of antibiotic appropriateness and patient outcomes, are needed to inform decisions on potential benchmarks for antibiotic de-escalation. BioMed Central 2016-12-12 /pmc/articles/PMC5153830/ /pubmed/27955625 http://dx.doi.org/10.1186/s12879-016-2080-3 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Liu, Peter
Ohl, Christopher
Johnson, James
Williamson, John
Beardsley, James
Luther, Vera
Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title_full Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title_fullStr Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title_full_unstemmed Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title_short Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program
title_sort frequency of empiric antibiotic de-escalation in an acute care hospital with an established antimicrobial stewardship program
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153830/
https://www.ncbi.nlm.nih.gov/pubmed/27955625
http://dx.doi.org/10.1186/s12879-016-2080-3
work_keys_str_mv AT liupeter frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram
AT ohlchristopher frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram
AT johnsonjames frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram
AT williamsonjohn frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram
AT beardsleyjames frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram
AT luthervera frequencyofempiricantibioticdeescalationinanacutecarehospitalwithanestablishedantimicrobialstewardshipprogram