急诊科环境下的抗生素降阶梯治疗经验：一项回顾性观察研究。

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

作者信息

Corcione Silvia, Mornese Pinna Simone, Lupia Tommaso, Trentalange Alice, Germanò Erika, Cavallo Rossana, Lupia Enrico, De Rosa Francesco Giuseppe

机构信息

Department of Medical Sciences, University of Turin, 10126 Turin, Italy.

Tufts University School of Medicine, Boston, MA 02129, USA.

出版信息

J Clin Med. 2021 Jul 26;10(15):3285. doi: 10.3390/jcm10153285.

DOI:10.3390/jcm10153285

PMID:34362069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8347329/

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% = 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.

摘要

背景

抗菌药物降阶梯治疗（ADE）是抗菌药物管理策略的一部分，旨在尽量减少不必要或不适当的抗生素暴露，以降低抗菌药物耐药率。目前缺乏关于急诊病房（EMW）中ADE有效性和安全性的信息。

方法

对入住EMW并接受经验性抗菌治疗的成年患者进行回顾性研究。主要结局是ADE的发生率和时间。次要结局包括与早期ADE相关的因素、住院时间和院内死亡率。

结果

共研究了336例患者。54.8%的患者最初使用两种药物联合治疗方案。脲基青霉素和碳青霉烯类是最常用的经验性治疗药物（分别为25.1%和13.6%）。处方适宜率为58.3%。111例（33%）患者进行了降阶梯治疗。患者在第2天（21%）、第3天（23%）和第5天（56%）成功实现降阶梯。总体院内死亡率为21%，降阶梯组显著低于继续治疗组（16%对25%，P = 0.003）。多因素分析显示，降阶梯策略以及适当的经验性和靶向治疗与死亡率降低相关。