Pharmaceutical Department, Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan.
Department of Pharmaceutical Regulatory Science, School of Pharmacy, Nihon University, Nrashino City, Chiba, Japan.
Pharmazie. 2022 Oct 1;77(10):311-315. doi: 10.1691/ph.2022.2455.
Antimicrobials should be used appropriately to minimise the risk of resistant strains arising in association with overuse. De-escalation of antimicrobial therapy is one strategy used to ensure appropriate use, but its safety and efficacy in burn patients are unclear. The aim of this study was to evaluate the safety and efficacy of de-escalation therapy for treating infections in burn patients. This retrospective cohort study investigated patients admitted to our intensive care unit with burns and treated for infection between October 1, 2013, and September 30, 2020. Patients were classified into a de-escalation group (Group D) comprising patients treated with empiric antimicrobial therapy followed by de-escalation and a non-de-escalation group (Group ND) comprising patients who did not undergo de-escalation. Characteristics and outcomes were compared between groups. Forty-three patients met the inclusion criteria, including 15 patients in Group D and 28 patients in Group ND. Bacterial species commonly detected in these patients were spp. (17.3%), (16.1%), and (9.6%) No inter-group difference was seen in 28-day mortality (6.7% vs 21.4%, =0.391). Multidrug-resistant strains were detected significantly less frequently in Group D (13.0%) than in Group ND (26.1%, =0.003). De-escalation was associated with use of two or more antimicrobials as empiric antimicrobial therapy. As the use of de-escalation in infection treatment did not impact 28-day mortality, de-escalation might be safe for treating infections in burn patients.
抗生素应合理使用，以最大限度地减少过度使用导致耐药菌株出现的风险。降低抗生素治疗强度是确保合理使用抗生素的一种策略，但在烧伤患者中的安全性和疗效尚不清楚。本研究旨在评估降低抗生素治疗强度治疗烧伤患者感染的安全性和疗效。这项回顾性队列研究调查了 2013 年 10 月 1 日至 2020 年 9 月 30 日期间因烧伤入住我院重症监护病房并接受感染治疗的患者。患者分为经验性抗生素治疗后进行降阶梯治疗的降阶梯组（D 组）和未进行降阶梯治疗的非降阶梯组（ND 组）。比较两组患者的特征和结局。43 例患者符合纳入标准，其中 D 组 15 例，ND 组 28 例。这些患者中常见的细菌种属为 spp.（17.3%）、 （16.1%）和 （9.6%）。28 天死亡率在两组间无差异（6.7% vs 21.4%， =0.391）。D 组中检测到的多药耐药菌株明显少于 ND 组（13.0% vs 26.1%， =0.003）。降阶梯与使用两种或两种以上抗生素作为经验性抗生素治疗相关。由于降阶梯治疗感染并未影响 28 天死亡率，因此降阶梯治疗可能对烧伤患者的感染治疗是安全的。
