Clinical benefits of antimicrobial de-escalation in adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia

doi:10.1016/j.ijantimicag.2017.03.024

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Title:	Clinical benefits of antimicrobial de-escalation in adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia
Authors:	Lee, Ching-Chi Wang, Jiun-Ling Lee, Chung-Hsun Hung, Yuan-Pin Hong, Ming-Yuan Tang, Hung-Jen Ko, Wen-Chien
Contributors:	Madou Sin Lau Hosp, Dept Internal Med, Div Crit Care Med Chang Jung Christian Univ, Coll Hlth Sci, Grad Inst Med Sci Natl Cheng Kung Univ,Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med Natl Cheng Kung Univ, Coll Med, Dept Med Natl Cheng Kung Univ Hosp, Dept Emergency Med Tainan Hosp, Minist Hlth & Welf, Dept Internal Med Chi Mei Med Ctr, Dept Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
Keywords:	De-escalation Bacteremia Escherichia coli Klebsiella species Proteus mirabilis
Date:	2017-09
Issue Date:	2018-11-30 15:52:01 (UTC+8)
Publisher:	Elsevier Science Bv
Abstract:	The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a noswitch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum betalactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first-or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group). The eligible 454 adults were categorized as the de-escalation (231 patients, 50.9%), no-switch (177, 39.0%), and escalation (46, 10.1%) groups. Patients with de-escalation therapy were more often female, had less critical illness and fatal comorbidity, and had a higher survival rate than patients in the other two groups. After propensity score matching in the de-escalation and no-switch groups, critical illness at onset (Pitt bacteremia score = 4; 16.5% vs. 12.7%; P = 0.34) or day 3 (2.5% vs. 2.5%; P = 1.00), fatal comorbidity (16.5% vs. 21.5%; P = 0.25), time to defervescence (4.6 vs. 4.7 days; P = 0.89), hospital stays (11.5 vs. 10.3 days; P = 0.13) and 4-week crude mortality rate (4.4% vs. 4.4%; P = 1.00) were similar. However, lower antibiotic cost (mean: 212.1 vs. 395.6 US$, P < 0.001) and fewer complications of bloodstream infections due to resistant pathogens (0% vs. 5.1%, P = 0.004) were observed in the de-escalation group. De-escalation to narrower-spectrum cephalosporins is safe and cost-effective for adults with community-onset EKP bacteremia stabilized by empirical broad-spectrum beta-lactams. (C) 2017 Elsevier B. V. and International Society of Chemotherapy. All rights reserved.
Relation:	International Journal of Antimicrobial Agents, v.50, n.3, pp.371-376
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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