De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study

Moraes, Rafael Barberena; Guillen, J. A. V.; Zabaleta, William Javier Castillo; Borges, Flávia Kessler

doi:10.5935/0103-507x.20160044

Cited by 19 publications

(22 citation statements)

References 23 publications

(38 reference statements)

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“…( 28 ) The percentage of positive blood cultures in our study was similar to that reported in previous studies. ( 29,30 ) Similarly, it has been described that patients with sepsis without focus and negative cultures have lower mortality than patients with positive cultures; ( 31 ) however, our findings, which we have corroborated in another recently published study, did not agree with this statement. ( 32 )…”

Section: Discussioncontrasting

confidence: 65%

Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia

Caraballo¹,

Ascuntar²,

Hincapié³

et al. 2019

Revista Brasileira De Terapia Intensiva

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Objective To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department. Methods This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality. Results The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024). Conclusions There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.

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Section: Discussioncontrasting

confidence: 65%

Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia

Caraballo¹,

Ascuntar²,

Hincapié³

et al. 2019

Revista Brasileira De Terapia Intensiva

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“…Despite this lack of overall evidence, ADE has been demonstrated to be safely and effectively performed in critically ill patients. [98][99][100][101] RDTs have the potential for further increasing the role of ADE in the ICU. However, to date there has been limited experience employing RDTs as a de-escalation tool in the critically ill population.…”

Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotimentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, and extended spectrum β-lactamase producing organisms, are urgent threats. The rising rates of antimicrobial resistance have resulted in routine empiric administration of broad-spectrum antibiotics by clinicians to critically ill patients even when bacterial infection is microbiologically absent. Moreover, new broad-spectrum antibiotics are a challenge to use effectively while avoiding emergence of further resistance. Use of rapid diagnostic technologies (RDTs) will likely provide an important methodology for achieving this important balance. There is an urgent need for integrating the administration of new and existing antibiotics with RDTs in a way that is safe, cost-effective, applicable in all countries, and sustainable.

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“…33 Similar results were established by research published in 2018, which discovered that 12.2% of patients were continued on antibiotics, surpassing 5 days of treatment, in the absence of clinical data and microbiology results. 34 In 2015, in a study where inappropriateness was determined by the absence of antimicrobials with activity against the isolated microorganism, inappropriateness was 12%. 35 However, these studies did not include children.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Antibiotic Treatment Review following Blood Culture Collection

Dhanda

Gray

Bashir

et al. 2019

J Pediatr Infect Dis

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Objective Inappropriate antibiotic treatment can significantly affect antimicrobial resistance, resulting in treatments becoming less effective in the future. Previous studies have not identified the possible de-escalation rate. The aim of this study was to assess the appropriateness of antibiotic treatment in patients who have a blood culture collected, in particular, calculating how many days of antibiotics can be de-escalated. Methods A patient series, observational study was conducted that included all patient blood culture, regardless of whether they were positive or negative, over a period of 4 days. The study was repeated three times to attain a larger sample. The adequacy of antibiotic treatment was determined based on microbiology results, prescription drug administration, and patient notes/charts. Results Of the 69 suitable cases, 36 (52.17%) received appropriate treatment and 33 (47.83%) received inappropriate treatment. Of the inappropriate cases, it was calculated that 83 days of de-escalation were possible. Fifteen (21%) of the cases could have de-escalated use of meropenem. Conclusion The results highlight that there is opportunity to review and de-escalate patient's treatment, after taking a blood culture and practices such as rationalizing antibiotic choices and educating physicians on reviewing antibiotics is appropriate.

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De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study

Cited by 19 publications

References 23 publications

Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia

Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Appropriateness of Antibiotic Treatment Review following Blood Culture Collection

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