Viasus Diego, Abelenda-Alonso Gabriela, Bolivar-Areiza Juan, Gudiol Carlota, Carratalà Jordi
Health Sciences Division, Faculty of Medicine, Hospital Universidad del Norte, Universidad del Norte, Barranquilla 080003, Colombia.
Infectious Disease Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Antibiotics (Basel). 2025 Jul 17;14(7):716. doi: 10.3390/antibiotics14070716.
: This study aimed to assess the effect of antibiotic de-escalation on 30-day mortality, duration of intravenous (IV) antibiotic therapy and length of hospital stay (LOS) in severe community-acquired pneumonia (sCAP). : We performed a retrospective analysis of prospectively collected data from a cohort of adults diagnosed with sCAP and microbiologically confirmed etiology between 1995 to 2022. Two distinct time points of the de-escalation were analyzed: 3 and 6 days post-admission, corresponding, respectively, to the availability of microbiological results and the median time to clinical stability. Inverse propensity score-weighted binary logistic regression was used to adjust for potential confounders. : A total of 398 consecutive cases of sCAP were analyzed. No significant differences were observed between the de-escalation and non-de-escalation groups in terms of age, sex, comorbidities, or severity-related variables (such as impaired consciousness, shock, respiratory failure, or multilobar pneumonia). Patients in the de-escalation group had lower rates of leukopenia, bacteremia and empyema, and less need for mechanical ventilation, with variations depending on the timing of de-escalation. After adjusting for confounding factors in an inverse propensity score-weighted analysis, de-escalation within 3 or 6 days after admission was not associated with increased mortality risk (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 0.29-7.4; = 0.63, and aOR 0.57, 95% CI 0.14-2.31, = 0.43, respectively). Similar findings were observed for prolonged LOS. However, antibiotic de-escalation was related to a lower risk of prolonged IV antibiotic. : Antibiotic de-escalation in microbiologically confirmed sCAP did not negatively impact clinical outcomes, supporting the safety of this strategy for optimizing antibiotic use in this serious infection.
本研究旨在评估抗生素降阶梯治疗对重症社区获得性肺炎（sCAP）患者30天死亡率、静脉（IV）抗生素治疗持续时间及住院时间（LOS）的影响。我们对1995年至2022年间诊断为sCAP且病因经微生物学确认的成年队列中前瞻性收集的数据进行了回顾性分析。分析了降阶梯治疗的两个不同时间点：入院后3天和6天，分别对应微生物学结果的可得性以及临床稳定的中位时间。采用逆倾向评分加权二元逻辑回归来调整潜在混杂因素。共分析了398例连续的sCAP病例。在年龄、性别、合并症或严重程度相关变量（如意识障碍、休克、呼吸衰竭或多叶肺炎）方面，降阶梯治疗组与非降阶梯治疗组之间未观察到显著差异。降阶梯治疗组患者白细胞减少、菌血症和脓胸的发生率较低，机械通气需求较少，且因降阶梯治疗的时机不同而有所差异。在逆倾向评分加权分析中调整混杂因素后，入院后3天或6天内的降阶梯治疗与死亡风险增加无关（调整后的优势比[aOR]分别为1.48，95%置信区间[CI]为0.29 - 7.4；P = 0.63，以及aOR为0.57，95% CI为0.14 - 2.31，P = 0.43）。对于住院时间延长也观察到了类似的结果。然而，抗生素降阶梯治疗与静脉抗生素治疗时间延长的风险较低有关。在微生物学确诊的sCAP中，抗生素降阶梯治疗对临床结局没有负面影响，支持了该策略在这种严重感染中优化抗生素使用的安全性。
