Palacios-Baena, Zaira RDelgado-Valverde, MercedesValiente Mendez, AdoracionAlmirante, BenitoGomez-Zorrilla, SilviaBorrell, NuriaCorzo, Juan EGurgui, MercedesDe la Calle, CristinaGarcia-Alvarez, LaraRamos, LuciaGozalo, MonicaMorosini, Maria IsabelMolina, JoseCausse, ManuelPascual, AlvaroRodríguez-Baño, Jesus2023-01-252023-01-252018-12-04Palacios-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):956-962http://hdl.handle.net/10668/13303More 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.enEnterobacteriaceaeBloodstream infectionsDe-escalationMortalityStreamliningÁrea de Gestión Sanitaria Sur de SevillaAgedBacteremiaEnterobacteriaceaeEnterobacteriaceae infectionsFemaleHumansMaleMiddle agedMortalityOdds ratioPrognosisProportional hazards modelsProspective studiesresearch article30535051open accessEstudios prospectivosInfecciones por EnterobacteriaceaeModelos de riesgos proporcionalesOportunidad relativaPronóstico10.1093/cid/ciy10321537-6591https://academic.oup.com/cid/article-pdf/69/6/956/29250373/ciy1032.pdf