Researchers conducted a post-hoc analysis of a prospective, multicenter cohort of 516 patients with bloodstream infection due to Enterobacteriaceae or BSI-E. The BSI-E was initially treated with ertapenem or antipseudomonal β-lactams.
They examined factors associated with early de-escalation as well as the effect of associated with early de-escalation and late de-escalation on 30-day all-cause mortality. Antibiotic de-escalation typically means reducing the spectrum of administered antibiotics by discontinuing certain drugs or switching to an agent with a narrower spectrum, according to a 2015 study in Current Opinion in Infectious Diseases.
The current study shows that early de-escalation was performed in 241 patients, late de-escalation in 98 and no de-escalation in 180.
Researchers found variables independently associated with a lower probability of early de-escalation were multidrug-resistant isolates and nosocomial infection empirically treated with imipenem or meropenem.
Additionally, they found early de-escalation was not associated with increased risk of mortality and late de-escalation was not associated with mortality. De-escalation was not associated with clinical failure nor did it affect length of hospital stay.
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