RT Journal Article
T1 Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort.
A1 Palacios-Baena, Zaira R
A1 Delgado-Valverde, Mercedes
A1 Valiente Mendez, Adoracion
A1 Almirante, Benito
A1 Gomez-Zorrilla, Silvia
A1 Borrell, Nuria
A1 Corzo, Juan E
A1 Gurgui, Mercedes
A1 De la Calle, Cristina
A1 Garcia-Alvarez, Lara
A1 Ramos, Lucia
A1 Gozalo, Monica
A1 Morosini, Maria Isabel
A1 Molina, Jose
A1 Causse, Manuel
A1 Pascual, Alvaro
A1 Rodríguez-Baño, Jesus
K1 Enterobacteriaceae
K1 Bloodstream infections
K1 De-escalation
K1 Mortality
K1 Streamlining
K1 Área de Gestión Sanitaria Sur de Sevilla
AB More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.
PB Oxford University Press
YR 2018
FD 2018-12-04
LK http://hdl.handle.net/10668/13303
UL http://hdl.handle.net/10668/13303
LA en
NO Palacios-Baena ZR, Delgado-Valverde M, Valiente Méndez A, Almirante B, Gómez-Zorrilla S, Borrell N, et al. Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort. Clin Infect Dis. 2019 Aug 30;69(6):956-962
DS RISalud
RD Apr 13, 2025