[Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections]
| Autor: | Diana P, Cuesta, Victor M, Blanco, Marta E, Vallejo, Cristhian, Hernández-Gómez, Juan J, Maya, Gabriel, Motoa, Adriana, Correa, Lorena, Matta, Fernando, Rosso, Ruben D, Camargo, Martin, Muñoz, Elizabeth, Florez, Jorge, Nagles, Amparo, Ovalle, Sergio, Reyes, María V, Villegas |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Ertapenem Male Time Factors Critical Illness Enterobacteriaceae Infections Kaplan-Meier Estimate Colombia Length of Stay Middle Aged Statistics Nonparametric Anti-Bacterial Agents Intensive Care Units Treatment Outcome Risk Factors Pseudomonas Humans Female Prospective Studies Aged Proportional Hazards Models |
| Zdroj: | Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia. 36(1) |
| ISSN: | 0717-6341 |
| Popis: | Ertapenem has proven to be effective for extended-spectrum beta-lactamases-producing Enterobacteriaceae but lacks activity against non-fermenters; de-escalation to this antibiotic may reduce the selection of resistance to Pseudomonas aeruginosa and improve clinical outcomes.To evaluate the clinical impact of de-escalation from broad-spectrum anti-pseudomonal agents to ertapenem, a non-pseudomonal antibiotics for Enterobacteriaceae infections in critically-ill patients.We conducted a prospective cohort study in adult patients admitted to intensive care units (ICUs) who had Enterobacteriaceae infections and were de-escalated from empiric anti-pseudomonal coverage to non-pseudomonal antibiotics. Cox proportional hazards models were performed comparing all-cause mortality and length of hospital stay between patients who remained on anti-pseudomonal coverage versus those who were de-escalated to ertapenem.105 patients in the anti-pseudomonal group were compared to 148 patients in the ertapenem de-escalation group. De-escalation was associated with lower all-cause mortality compared to patients who remained on anti-pseudomonal coverage (adjusted Hazard Ratio 0.24; 95% CI: 0.12-0.46). The length of ICU stay was similar between the groups.ICU patients with Enterobacteriaceae infections de-escalated to ertapenem therapy had better outcomes compared to patients who remained on broad-spectrum, anti-pseudomonal therapy, suggesting that de-escalation is a safe approach amongst ICU patients. |
| Databáze: | OpenAIRE |
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