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Background <p>The alarming rate of bacterial resistance has urged for vigorous antibiotic de-escalation cultures worldwide. However, the art of de-escalation remains challenging as most clinicians have the fear or stigma that antibiotic de-escalation is strongly associated with higher mortality. This study aimed to determine the factors strongly correlated with higher mortality rates after antibiotic de-escalation and possibly serve as a benchmark study for developing a validated antibiotic de-escalation tool in the near future.</p> Method <p>This retrospective study was conducted on patients hospitalized in a medical intensive care unit of a referral tertiary care center and subjected to antibiotics de-escalation over five years. Independent factors associated with mortality post antibiotics de-escalation were assessed. Various data were collected, including patient demographics, admission and discharge dates, a primary source of infection and free of infection status, choices of antibiotic used and de-escalation history, vital signs, data on X-ray changes, relevant laboratory investigations, microbiological culture history, mortality status, history of COVID-19 infection, presence of central line, number of vasopressors used, ventilator settings and respective SOFA scores.</p> Results <p>Prevalence of mortality among patients continued on broad-spectrum antibiotics empirically is remarkable. Through this study, it was found that the significant factors associated with mortality post antibiotic de-escalation were hospital-acquired infection (HAI) (Adjusted OR: 12.56; 95% CI: 2.88,54.98; <i>p</i> &lt; 0.001), systolic blood pressure in mmHg (Adjusted OR: 0.08; 95% CI: 0.02,0.33; <i>p</i> &lt; 0.001), heart rate in bpm (Adjusted OR: 0.12; 95% CI: 0.03,0.45; p:0.002), SOFA scores (Adjusted OR: 21.44; 95% CI: 3.55,129.52; p:0.001) and number of vasopressors (Adjusted OR: 38.46; 95% CI: 1.54,959.30; p:0.026).</p> Conclusion <p>De-escalation of antibiotics is considerable as the identified significant factors serve as baseline predictors which would certainly be helpful especially during the decision-making process of antibiotic de-escalation among the clinicians. Therefore, antibiotics de-escalation is highly encouraged to reduce the mortality risks.</p>

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Baseline predictors of antibiotics de-escalation from empirical therapies in an intensive care unit: a five-year retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月17日

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  • Ann Lisa Arulappen,
  • Amer Hayat Khan,
  • Monica Danial,
  • Syed Shahzad Hasan,
  • Ting Soo Chow,
  • Nehad Jaser Ahmed,
  • Chiau Ming Long

摘要

Background

The alarming rate of bacterial resistance has urged for vigorous antibiotic de-escalation cultures worldwide. However, the art of de-escalation remains challenging as most clinicians have the fear or stigma that antibiotic de-escalation is strongly associated with higher mortality. This study aimed to determine the factors strongly correlated with higher mortality rates after antibiotic de-escalation and possibly serve as a benchmark study for developing a validated antibiotic de-escalation tool in the near future.

Method

This retrospective study was conducted on patients hospitalized in a medical intensive care unit of a referral tertiary care center and subjected to antibiotics de-escalation over five years. Independent factors associated with mortality post antibiotics de-escalation were assessed. Various data were collected, including patient demographics, admission and discharge dates, a primary source of infection and free of infection status, choices of antibiotic used and de-escalation history, vital signs, data on X-ray changes, relevant laboratory investigations, microbiological culture history, mortality status, history of COVID-19 infection, presence of central line, number of vasopressors used, ventilator settings and respective SOFA scores.

Results

Prevalence of mortality among patients continued on broad-spectrum antibiotics empirically is remarkable. Through this study, it was found that the significant factors associated with mortality post antibiotic de-escalation were hospital-acquired infection (HAI) (Adjusted OR: 12.56; 95% CI: 2.88,54.98; p < 0.001), systolic blood pressure in mmHg (Adjusted OR: 0.08; 95% CI: 0.02,0.33; p < 0.001), heart rate in bpm (Adjusted OR: 0.12; 95% CI: 0.03,0.45; p:0.002), SOFA scores (Adjusted OR: 21.44; 95% CI: 3.55,129.52; p:0.001) and number of vasopressors (Adjusted OR: 38.46; 95% CI: 1.54,959.30; p:0.026).

Conclusion

De-escalation of antibiotics is considerable as the identified significant factors serve as baseline predictors which would certainly be helpful especially during the decision-making process of antibiotic de-escalation among the clinicians. Therefore, antibiotics de-escalation is highly encouraged to reduce the mortality risks.