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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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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 |
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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 |
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