Department of Pharmacy, the Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, China.
Department of Pharmacy, Northwest Women's and Children's Hospital, Shaanxi, 710061, Xi'an, China.
BMC Infect Dis. 2023 Aug 4;23(1):508. doi: 10.1186/s12879-023-08491-7.
This study aimed to investigate the prevalence of antimicrobial de-escalation (ADE) strategy and assess its effect on 14-day mortality among intensive care unit patients.
A single-center retrospective cohort study was conducted on patients admitted to the intensive care unit (ICU) with infectious diseases between January 2018 and December 2020. Patients were stratified into three groups based on the initial treatment regimen within 5 days of antimicrobial administration: ADE, No Change, and Other Change. Confounders between groups were screened using one-way ANOVA and Chi-square analysis. Univariate and multivariate analyses were performed to identify risk factors for 14-day mortality. Potential confounders were balanced using propensity score inverse probability of treatment weighting (IPTW), followed by multivariate logistic regression analysis to evaluate the effect of ADE strategy on 14-day mortality.
A total of 473 patients met the inclusion criteria, with 53 (11.2%) in the ADE group, 173 (36.6%) in the No Change group, and 247 (52.2%) in the Other Change group. The 14-day mortality rates in the three groups were 9.4%, 11.6%, and 21.9%, respectively. After IPTW, the adjusted odds ratio for 14-day mortality comparing No Change with ADE was 1.557 (95% CI 1.078-2.247, P = 0.0181) while comparing Other Change with ADE was 1.282(95% CI 0.884-1.873, P = 0.1874).
The prevalence of ADE strategy was low among intensive care unit patients. The ADE strategy demonstrated a protective effect or no adverse effect on 14-day mortality compared to the No Change or Other Change strategies, respectively. These findings provide evidence supporting the implementation of the ADE strategy in ICU patients.
本研究旨在调查抗菌药物降阶梯（ADE）策略的流行情况，并评估其对重症监护病房（ICU）患者 14 天死亡率的影响。
对 2018 年 1 月至 2020 年 12 月期间因感染性疾病入住 ICU 的患者进行了一项单中心回顾性队列研究。根据抗菌药物治疗开始后 5 天内的初始治疗方案，将患者分为三组：ADE、无变化和其他变化。使用单因素方差分析和卡方检验筛选组间混杂因素。采用单因素和多因素分析确定 14 天死亡率的危险因素。使用倾向评分逆概率治疗加权（IPTW）平衡潜在混杂因素，然后进行多因素逻辑回归分析，以评估 ADE 策略对 14 天死亡率的影响。
共纳入 473 例符合条件的患者，其中 ADE 组 53 例（11.2%），无变化组 173 例（36.6%），其他变化组 247 例（52.2%）。三组患者的 14 天死亡率分别为 9.4%、11.6%和 21.9%。经过 IPTW 校正后，无变化组与 ADE 组相比，14 天死亡率的调整比值比为 1.557（95%可信区间 1.078-2.247，P=0.0181），而其他变化组与 ADE 组相比，14 天死亡率的调整比值比为 1.282（95%可信区间 0.884-1.873，P=0.1874）。
ICU 患者中 ADE 策略的应用率较低。与无变化或其他变化策略相比，ADE 策略对 14 天死亡率表现出保护作用或无不良影响。这些发现为在 ICU 患者中实施 ADE 策略提供了证据支持。
