ArticleInfection2011
De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients.
Article in Infection, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis.Frontiers in medicine · 2022Pooled it
- De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock.The Cochrane database of systematic reviews · 2013Pooled it
- Trial
- De-escalation of antimicrobial therapy for bacteraemia due to difficult-to-treat Gram-negative bacilli.Infection · 2013Trial
- Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics.Infection and drug resistance · 2018Review
- Observational
- Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program.BMC infectious diseases · 2016Article
- Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases.Infection · 2016Article
- Antimicrobial de-escalation of treatment for healthcare-associated pneumonia within the Veterans Healthcare Administration.The Journal of antimicrobial chemotherapy · 2016Article
- Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study.Critical care research and practice · 2016Article
- Treatment of bloodstream infections in ICUs.BMC infectious diseases · 2014Review
- Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome.Infection · 2014Article
- The Japanese guidelines for the management of sepsis.Journal of intensive care · 2014Article
- De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock.Intensive care medicine · 2014Article
- Safety and feasibility of antibiotic de-escalation in bacteremic pneumonia.Infection and drug resistance · 2014Article
- Optimizing antimicrobial therapy in critically ill patients.Infection and drug resistance · 2014Review
- Septic pulmonary embolism originated from subcutaneous abscess after living donor liver transplantation: a pitfall of postoperative management.Clinical journal of gastroenterology · 2013Article
- Clinical manifestations and prognostic factor of iliopsoas abscess.Journal of global infectious diseases · 2013Article
- Antimicrobial de-escalation in cancer patients.Infection · 2012Article
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe aim of this study was to examine the safety and efficacy of de-escalating antimicrobial therapy in immunocompetent patients presenting with bacteraemia due to antibiotic-sensitive pathogens.
methodsWe screened 1,350 positive blood cultures identified in a single, 1,065-bed university hospital over 5 years, and retained 310 cases of bacteraemia due to antibiotic-sensitive pathogens, including (1) methicillin-sensitive staphylococci, (2) penicillin-sensitive streptococci, (3) β-lactam-sensitive (a) Escherichia coli, and (b) Klebsiella species. The efficacy of appropriate initial empirical antimicrobial therapy, the performance of de-escalated pathogen-directed therapy, and the safety and efficacy of de-escalated therapy were evaluated.
resultsAmong 270 appropriately treated patients, 16 (6%) died, versus 6 (15%) among 40 who were inappropriately treated (p = 0.04). While 201 of 270 patients (74%) who received appropriate initial empirical therapy were candidates for de-escalation, the treatment was de-escalated in only 79 (39%). De-escalation was associated with (1) a trend toward a lower (a) death rate (1 vs. 5%) and (b) treatment failure (4 vs. 10%), and (2) (a) a 4-day longer median duration and (b) a $50 higher median cost of antimicrobial therapy (p < 0.001).
conclusionsWhen the pathogen was sensitive to antimicrobial therapy and the initial empirical treatment was effective, de-escalation of antimicrobial therapy in immunocompetent patients with bacteraemia was safe and associated with acceptable outcomes. The rate of de-escalation of antimicrobial therapy was low.
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