Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study.

Autor:	Patanwala AE; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia., Abu Sardaneh A; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia., Alffenaar JC; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.; The University of Sydney Institute for Infectious Diseases (Sydney ID), Westmead, NSW, Australia.; Westmead Hospital, Westmead, NSW, Australia., Choo CL; Department of Pharmacy, John Hunter Hospital, New Lambton Heights, NSW, Australia., Dey AL; Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia., Duffy EJ; Infectious Disease, Auckland City Hospital, Auckland, New Zealand.; School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand., Green SE; Department of Pharmacy, Royal North Shore Hospital, St Leonards, NSW, Australia., Hills TE; Medical Research Institute of New Zealand, Wellington, New Zealand., Howle LM; Pharmacy Department, Tamworth Hospital, Tamworth, NSW, Australia., Joseph JA; Department of Pharmacy, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia., Khuon MC; Department of Pharmacy, Concord Repatriation General Hospital, Concord, NSW, Australia., Koppen CS; Department of Pharmacy, John Hunter Hospital, New Lambton Heights, NSW, Australia., Pang F; Department of Pharmacy, Concord Repatriation General Hospital, Concord, NSW, Australia., Park JY; Department of Pharmacy, Westmead Hospital, Westmead, NSW, Australia., Parlicki MA; Department of Pharmacy, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia., Shah IS; Department of Pharmacy, Blacktown and Mount Druitt Hospital, Blacktown, NSW, Australia., Tran K; Department of Pharmacy, Blacktown and Mount Druitt Hospital, Blacktown, NSW, Australia., Tran P; Department of Pharmacy, Campbelltown Hospital, Campbelltown, NSW, Australia., Wills MA; Pharmacy Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia., Xu JH; Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia., Youssef M; Department of Pharmacy, Campbelltown Hospital, Campbelltown, NSW, Australia.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2024 Aug 27, pp. 10600280241271223. Date of Electronic Publication: 2024 Aug 27.
DOI:	10.1177/10600280241271223
Abstrakt:	Background: There is little known about antibiotic de-escalation (ADE) practices in the intensive care unit (ICU). Objective: The objective was to determine the proportion of patients who received ADE within 24 hours of actionable cultures and identify predictors of timely ADE. Methods: Multicenter cohort study in ICUs of 15 hospitals in Australia and New Zealand. Adult patients were included if they were started on broad-spectrum antibiotics within 24 hours of ICU admission. The ADE was defined as switching from a broad-spectrum agent to a narrower-spectrum agent or antibiotic cessation. The primary outcome was ADE within 24 hours of an actionable culture, where ADE was possible. Results: The 446 patients included in the study had a mean age of 63 ± 16 years, 60% were male, 32% were mechanically ventilated, and 19% were immunocompromised. Of these, 161 (36.1%) were not eligible for ADE and 37 (8.3%) for whom ADE within 24 hours of actionable culture could not be determined. In the remaining 248 patients, ADE occurred ≤24 hours in 60.5% (n = 150/248) after actionable cultures. In the multivariable logistic regression analysis, ADE was less likely to occur within 24 hours for patients with negative cultures (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.25-0.92, P = 0.03). Conclusion and Relevance: Timely ADE may not occur in 40% of patients in the ICU and is less likely to occur in patients with negative cultures. Timely ADE can be improved, and patients with negative cultures should be targeted as part of antimicrobial stewardship efforts. Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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