tailieunhanh - Báo cáo y học: "De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit. | Morel et al. Critical Care 2010 14 R225 http content 14 6 R225 KS CRITICAL CARE RESEARCH Open Access De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit 1 1 1 2 1 1 1 Jerome Morel Julie Casoetto Richard Jospé Gérald Aubert Raphael Terrana Alain Dumont Serge Molliex Christian Auboyer1 Abstract Introduction Most data on de-escalation of empirical antimicrobial therapy has focused on ventilator-associated pneumonia. In this retrospective monocentric study we evaluated de-escalation as part of a global strategy of empiric antibiotherapy management irrespective of the location and the severity of the infection. The goal of this trial was to assess the application of a de-escalation strategy and the impact in terms of re-escalation recurrent infection and to identify variables associated with de-escalation. Methods All consecutive patients treated with empiric antibiotic therapy and hospitalized in the intensive care unit for at least 72 hours within a period of 16 months were included. We compared the characteristics and outcome of patients who have experienced de-escalation therapy with those who have not. Results A total of 116 patients were studied corresponding to 133 infections. Antibiotic therapy was de-escalated in 60 cases 45 . De-escalation primarily accomplished by a reduction in the number of antibiotics used was observed in 52 of severe sepsis or septic shock patients. Adequate empiric antibiotic and use of aminoglycoside were independently linked with de-escalation. De-escalation therapy was associated with a significant reduction of recurrent infection 19 vs 5 P . Mortality was not changed by de-escalation. Conclusions As part of a global management of empiric antibiotherapy in an intensive care unit de-escalation might be safe and feasible in a large proportion of patients. Introduction The emergence of multidrug-resistant MDR pathogens is a major