Abstract
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.
Highlights
Antimicrobial stewardship (AS) is increasingly recognized as an important multifaceted tool for minimizing unnecessary or inappropriate antibiotic exposure and thereby reducing the rate of antimicrobial resistance (AMR) and associated healthcare costs [1]
Considering the few experiences reported in this setting, the purpose of this study was to examine and describe the prevalence of Antimicrobial de-escalation (ADE) and the associated factors in a retrospective cohort of patients admitted to a single emergency ward
Patients were eligible for evaluation if they met all the following criteria: were primarily admitted to the emergency medicine wards (EMW) or moved from another ward because of worsening of general conditions; had signs or symptoms suggestive of sepsis or required advanced ventilatory support without an endotracheal tube; had blood cultures (BCs) collected; and were treated with an empirical antibiotic treatment
Summary
Antimicrobial stewardship (AS) is increasingly recognized as an important multifaceted tool for minimizing unnecessary or inappropriate antibiotic exposure and thereby reducing the rate of antimicrobial resistance (AMR) and associated healthcare costs [1]. AS initiatives strongly promote early de-escalation treatment strategies and narrow the spectrum or reduce the number of molecules of an empiric antimicrobial treatment once culture results are available. Antimicrobial de-escalation (ADE) is a critical aspect of AS programmes. It is strictly dependent on multiple factors, such as the early collection of adequate microbiological samples, pathogen identification, and the administration of an initial anti-infective regimen [2,3]. 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. Methods: Adult patients admitted to EMW and receiving empiric antimicrobial treatment were retrospectively studied. Secondary outcomes included factors associated with early ADE, length of stay, and in-hospital mortality.
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