Back to Search
Start Over
Impact of antimicrobial strategies on clinical outcomes of adults with septic shock and community-onset Enterobacteriaceae bacteremia: de-escalation is beneficial
- Source :
- Diagnostic Microbiology and Infectious Disease. 82:158-164
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- To investigate the clinical outcomes of patients with septic shock related to community-onset monomicrobial Enterobacteriaceae (CoME) bacteremia as categorized by the strategy of antimicrobial therapy, a retrospective and observational study was conducted. Clinical information on the patients was obtained from medical records. Antibiotic regimens were ranked according to their activity spectrum against Enterobacteriaceae (category IV, highest; I, lowest). De-escalation was defined as a switch to a category with a narrower spectrum of coverage within 5days after the bacteremic onset. Of the 189 eligible patients, 86 (45.5%) patients received de-escalation antibiotic therapy, and most (48, 55.8%) of the patients were empirically treated first with a category IV antibiotic. In a multivariate analysis for 28-day mortality, of several independent predictors, the de-escalation strategy was protective (odds ratio, 0.37; P=0.04). In conclusion, for patients with CoME bacteremia and available susceptibility data, de-escalation of antimicrobial therapy was beneficial for improving clinical outcome.
- Subjects :
- Adult
Male
Microbiology (medical)
medicine.medical_specialty
medicine.drug_class
Antibiotics
Bacteremia
Internal medicine
medicine
Humans
Intensive care medicine
Aged
Retrospective Studies
Aged, 80 and over
Septic shock
business.industry
Medical record
Enterobacteriaceae Infections
General Medicine
Odds ratio
Middle Aged
medicine.disease
Antimicrobial
Shock, Septic
Survival Analysis
Anti-Bacterial Agents
Community-Acquired Infections
Treatment Outcome
Infectious Diseases
Female
Observational study
business
De-escalation
Subjects
Details
- ISSN :
- 07328893
- Volume :
- 82
- Database :
- OpenAIRE
- Journal :
- Diagnostic Microbiology and Infectious Disease
- Accession number :
- edsair.doi.dedup.....6a16c612d87a51df38697f0e0ee41727