De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Abhishek DeshpandeMichael B Rothberg

Abstract

For patients at risk for multidrug-resistant organisms, IDSA/ATS guidelines recommend empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. Following negative cultures, the guidelines recommend antimicrobial de-escalation. We assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients with pneumonia with negative cultures. We included adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. De-escalation was defined as stopping both empiric drugs on day 4 while continuing another antibiotic. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration (ICU transfer), length-of-stay (LOS), and costs. We also compared adjusted outcomes across hospital de-escalation rate quartiles. Of 14 170 patients, 1924 (13%) had both initial empiric drugs stopped by hospital day 4. Hospital de-escalation rates ranged from 2-35% and hospital de-escalation rate quartile was not significantly associated with outcomes. At hospitals in the top quartile of d...Continue Reading

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Citations

Aug 3, 2020·Current Opinion in Critical Care·Adrian John Brink, Guy Richards
Jul 11, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Abhishek Deshpande, Michael B Rothberg
Jun 13, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Mathieu Blot, Aurélien Dinh
Aug 28, 2021·Critical Care : the Official Journal of the Critical Care Forum·Michael S NiedermanGirish B Nair

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