Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit

Niimura, Takahiro; Zamami, Yoshito; Imai, Toru; Nagao, Kanako; Kayano, Masafumi; Sagara, Hidenori; Goda, Mitsuhiro; Okada, Naoto; Chuma, Masayuki; Takechi, Kenshi; Imanishi, Masaki; Koyama, Toshihiro; Koga, Tadashi; Nakura, Hironori; Sendo, Toshiaki; Ishizawa, Keisuke

doi:10.18433/jpps29737

Cited by 6 publications

(6 citation statements)

References 14 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multivariate analysis results showed that ADE strategies ( p = 0.013) and appropriate antibiotic treatment, either empiric ( p = 0.007) or targeted ( p = 0.006), were associated with reduced mortality. Our results are in line with other studies on severely ill patients [ 10 , 11 , 12 ]. The overall rate of methicillin resistance (13%) and multi-drug resistant Enterobacteriaceae (14%) hampered the possibility of ADE and could partially explain the low rate of ADE reported here.…”

Section: Discussionsupporting

confidence: 94%

Antibiotic De-escalation Experience in the Setting of Emergency Department: A Retrospective, Observational Study

Corcione

Pinna

Lupia

et al. 2021

JCM

View full text Add to dashboard Cite

Background: Antimicrobial de-escalation (ADE) is a part of antimicrobial stewardship strategies aiming to minimize unnecessary or inappropriate antibiotic exposure to decrease the rate of antimicrobial resistance. Information regarding the effectiveness and safety of ADE in the setting of emergency medicine wards (EMW) is lacking. Methods: Adult patients admitted to EMW and receiving empiric antimicrobial treatment were retrospectively studied. The primary outcome was the rate and timing of ADE. Secondary outcomes included factors associated with early ADE, length of stay, and in-hospital mortality. Results: A total of 336 patients were studied. An initial regimen combining two agents was prescribed in 54.8%. Ureidopenicillins and carbapenems were the most frequently empiric treatment prescribed (25.1% and 13.6%). The rate of the appropriateness of prescribing was 58.3%. De-escalation was performed in 111 (33%) patients. Patients received a successful de-escalation on day 2 (21%), 3 (23%), and 5 (56%). The overall in-hospital mortality was 21%, and it was significantly lower among the de-escalation group than the continuation group (16% vs 25% p = 0.003). In multivariate analysis, de-escalation strategies as well as appropriate empiric and targeted therapy were associated with reduced mortality. Conclusions: ADE appears safe and effective in the setting of EMWs despite that further research is warranted to confirm these findings.

show abstract

Section: Discussionsupporting

confidence: 94%

Antibiotic De-escalation Experience in the Setting of Emergency Department: A Retrospective, Observational Study

Corcione

Pinna

Lupia

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…De-escalation as part of a stewardship programme does not affect rate of mortality or recurrence rates 1 . In a retrospective study in a critical care unit of patients with bacteraemia, de-escalation of antibiotic treatment reduced the duration of treatment and length of hospital stay 9 . In particular, use of carbapenem was reduced.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a rapid diagnostic test to exclude bacteraemia and effect on clinical decision-making for antimicrobial therapy

Yui

Bercades

Muzslay

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Unnecessary antimicrobial treatment promotes the emergence of resistance. Early confirmation that a blood culture is negative could shorten antibiotic courses. the cognitor Minus test, performed on blood culture samples after 12 hours incubation has a negative predictive value (NPV) of 99.5%. The aim of this study was to determine if earlier confirmation of negative blood culture result would shorten antibiotic treatment. Paired blood cultures were taken in the Critical Care Unit at a teaching hospital. the cognitor Minus test was performed on one set >12 hours incubation but results kept blind. Clinicians were asked after 24 and 48 hours whether a result excluding bacteraemia or fungaemia would affect decisions to continue or stop antimicrobial treatment. Over 6 months, 125 patients were enrolled. The median time from start of incubation to Cognitor Minus test was 27.1 hours. When compared to 5 day blood culture results from both the control and test samples, Cognitor Minus gave NPVs of 99% and 100% respectively. Test results would have reduced antibiotic treatment in 14% (17/119) of patients at 24 and 48 hours (24% at either time) compared with routine blood culture. The availability of rapid tests to exclude bacteraemia may be of benefit in antimicrobial stewardship.

show abstract

“…With regard to the undesired effects of de‐escalation interventions, one RCT ( n = 116) 104 showed that the 90‐day mortality rate was 78 more per 1,000 (95%CI: 64 fewer to 335 more). On the other hand, the mortality rate due to long‐term follow‐ups in 13 observational studies ( n = 3,635) 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 was 80 fewer per 1,000 (95%CI: 114 fewer to 40 fewer). The quality of the evidence for all of these was “very low.” The incidence of superinfections was 166 more per 1,000 (95%CI: 8 more to 539 more) in the RCTs; however, no observational studies have evaluated these outcomes.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 98%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

View full text Add to dashboard Cite

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

show abstract

Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit

Cited by 6 publications

References 14 publications

Antibiotic De-escalation Experience in the Setting of Emergency Department: A Retrospective, Observational Study

Antibiotic De-escalation Experience in the Setting of Emergency Department: A Retrospective, Observational Study

Assessment of a rapid diagnostic test to exclude bacteraemia and effect on clinical decision-making for antimicrobial therapy

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Contact Info

Product

Resources

About