Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, MBC J-11, P.O. Box 40047, Jeddah, 21499, Saudi Arabia.
Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Epidemiol Glob Health. 2023 Sep;13(3):444-452. doi: 10.1007/s44197-023-00124-1. Epub 2023 Jun 9.
Antibiotic de-escalation (ADE) in critically ill patients is controversial. Previous studies mainly focused on mortality; however, data are lacking about superinfection. Therefore, we aimed to identify the impact of ADE versus continuation of therapy on superinfections rate and other outcomes in critically ill patients.
This was a two-center retrospective cohort study of adults initiated on broad-spectrum antibiotics in the intensive care unit (ICU) for ≥ 48 h. The primary outcome was the superinfection rate. Secondary outcomes included 30-day infection recurrence, ICU and hospital length of stay, and mortality.
250 patients were included, 125 in each group (ADE group and continuation group). Broad spectrum antibiotic discontinuation occurred at a mean of 7.2 ± 5.2 days in the ADE arm vs. 10.3 ± 7.7 in the continuation arm (P value = 0.001). Superinfection was numerically lower in the ADE group (6.4% vs. 10.4%; P = 0.254), but the difference was not significant. Additionally, the ADE group had shorter days to infection recurrence (P = 0.045) but a longer hospital stay (26 (14-46) vs. 21 (10-36) days; P = 0.016) and a longer ICU stay (14 (6-23) vs. 8 (4-16) days; P = 0.002).
No significant differences were found in superinfection rates among ICU patients whose broad-spectrum antibiotics were de-escalated versus patients whose antibiotics were continued. Future research into the association between rapid diagnostics with antibiotic de-escalation in the setting of high resistance is warranted.
在危重症患者中，抗生素降阶梯（ADE）存在争议。先前的研究主要集中在死亡率上；然而，关于继发感染的数据却很缺乏。因此，我们旨在确定与继续治疗相比，ADE 对危重症患者继发感染率和其他结局的影响。
这是一项在重症监护病房（ICU）中接受广谱抗生素治疗≥48 小时的成人的两中心回顾性队列研究。主要结局是继发感染率。次要结局包括 30 天内感染复发、ICU 和住院时间以及死亡率。
共纳入 250 例患者，每组 125 例（ADE 组和继续治疗组）。ADE 组抗生素的平均停药时间为 7.2±5.2 天，而继续治疗组为 10.3±7.7 天（P 值=0.001）。ADE 组继发感染的发生率略低（6.4%比 10.4%；P=0.254），但差异无统计学意义。此外，ADE 组的感染复发时间更短（P=0.045），但住院时间更长（26（14-46）比 21（10-36）天；P=0.016），ICU 入住时间更长（14（6-23）比 8（4-16）天；P=0.002）。
在广谱抗生素降阶梯与继续治疗的 ICU 患者中，继发感染率没有显著差异。未来需要研究在高耐药性情况下，快速诊断与抗生素降阶梯之间的关联。
