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De-escalation therapy among bacteremic patients with community-acquired pneumonia.
Clin Microbiol Infect. 2015 Jun 23;
Authors: Carugati M, Franzetti F, Wiemken T, Kelly R, Peyrani P, Blasi F, Ramirez J, Aliberti S
Abstract
No evidence supports the use of de-escalation therapy (DET) among patients with community-acquired pneumonia (CAP). We assessed the outcomes associated with DET among bacteremic CAP patients. We performed a secondary analysis of the Community-Acquired Pneumonia Organization database, which contains data on 660 bacteremic patients hospitalized because of CAP in 35 countries (2001-2013). Exclusion criteria were death within 72 hours from admission and inappropriate empirical antibiotic regimen. DET was defined as changing an appropriate empirical broad-spectrum regimen to a narrower-spectrum regimen according to culture results within 7 days from hospital admission. Two study groups were identified: patients whose antibiotic therapy was de-escalated (Group DET) or not (Group N-DET). Primary study outcome was 30-day mortality. 261 bacteremic CAP patients were included. Gram-positive bacteria were responsible for 88.1% of the cases (S. pneumoniae, 75.9%). Gram-negative bacteria accounted for 7.3% of the cases. DET was performed in 165 patients (63.2%). The N-DET Group was characterized by a more severe presentation at admission. After adjustment for confounders, DET was not associated with an increased risk of 30-day mortality. DET seems to be safe among bacteremic patients with CAP. Randomized clinical trials are warranted to further explore these findings.
PMID: 26115864 [PubMed - as supplied by publisher]