Heenen S et al. – Even in a highly focused environment with close collaboration among intensivists and infectious disease specialists, de–escalation may actually be possible in <50% of cases.
One hundred sixty-nine patients with 216 episodes of severe sepsis attributable to a hospital-acquired infection who required broad-spectrum β-lactam antibiotics alone or in association with other anti-infectious agents.
The major sources of infection were the lungs (44%) and abdomen (38%).
Microbiological data were available in 167 of the 216 episodes (77%).
Initial antimicrobial therapy was inappropriate in 27 episodes (16% of culture-positive episodes).
De-escalation was applied in 93 episodes (43%), escalation was applied in 22 episodes (10%), mixed changes were applied in 24 (11%) episodes, and there was no change in empirical antibiotic therapy in 77 (36%) episodes.
In these 77 episodes, the reasons given for maintaining the initial antimicrobial therapy included the sensitivity pattern of the causative organisms and previous antibiotic therapy.
The number of episodes when the chance to de-escalate may have been missed was small (4 episodes [5%]).
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