Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain.
Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain.
J Infect Public Health. 2020 Apr;13(4):558-563. doi: 10.1016/j.jiph.2019.09.014. Epub 2019 Nov 1.
Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors.
This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions.
De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p=0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p<0.001), although their exposure to carbapenems was lower (4 vs 6 days, p<0.001). Factors associated with de-escalation were ICU stay for at least 48h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality.
Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate.
碳青霉烯类抗生素被认为是治疗严重产超广谱β-内酰胺酶革兰氏阴性细菌感染的首选药物。我们的目的是分析在一家三级西班牙医院治疗的复杂尿路感染（UTI）中碳青霉烯类药物降级治疗的结果，并评估药师建议在这种实践中的影响、获得的结果和相关因素。
这是一项关于碳青霉烯类药物处方和降级治疗效果的前瞻性观察研究，在一家三级医院进行，时间为 2013 年 8 月 1 日至 2014 年 7 月 31 日。收集了碳青霉烯类药物治疗持续时间、降级、住院时间、死亡率和相关再入院的数据。
仅对培养阳性的患者进行了降级治疗，在 163 例复杂 UTI 患者中，有 49.7%进行了降级治疗。超过一半（69.1%）的药师干预得到了接受。降级治疗将中位住院时间缩短了五天（p=0.030）。降级组的住院死亡率较低（7.4%比 29.3%，p<0.001），但他们接触碳青霉烯类药物的时间较短（4 天比 6 天，p<0.001）。与降级相关的因素包括 ICU 至少停留 48 小时、药师建议以及产 ESBL 或 AmpC 的肠杆菌科细菌。与住院死亡率相关的因素包括年龄、既往住院和住院时间，但与药师建议无关。否则，碳青霉烯类药物降级治疗与住院死亡率的保护作用相关。
根据药师建议进行碳青霉烯类药物降级治疗在复杂 UTI 中是一种安全的方法，可以缩短患者的住院时间，而不会影响再入院率。
