ArticleThe Journal of antimicrobial chemotherapy2016
Antimicrobial de-escalation of treatment for healthcare-associated pneumonia within the Veterans Healthcare Administration.
Article in The Journal of antimicrobial chemotherapy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05568654 (Reducing Antimicrobial Overuse Through Targeted Therapy for Patients With Community-Acquired Pneumonia), which is not on this map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Reducing Antimicrobial Overuse Through Targeted Therapy for Patients With Community-Acquired Pneumonia
Who cites it
14 citing papers in PubMed.
- Clinical Impact of the BIOFIRE® FILMARRAY® Pneumonia Panel in the Veterans Affairs Healthcare System: A Difference-in-Differences Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- Assessment of antibiotic utilization patterns in an Indian Level-1 Trauma Center: a pilot study exploring days of antibiotic spectrum coverage and defined daily doses using WHO AWaRe classification trends.Frontiers in antibiotics · 2025Article
- Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study.Antibiotics (Basel, Switzerland) · 2022Article
- Antibiotic Use and Presumptive Pathogens in the Veterans Affairs Healthcare System.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Observational
- Desirability of Outcome Ranking for the Management of Antimicrobial Therapy (DOOR MAT) Reveals Improvements in the Treatment of Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumoniae in Patients from the Veterans Health Administration.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Impact of an antimicrobial stewardship in a 126-bed community hospital with close communication between pharmacists working on post-prescription audit, ward pharmacists, and the antimicrobial stewardship team.Journal of pharmaceutical health care and sciences · 2021Article
- De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Pneumococcal Urinary Antigen Testing in United States Hospitals: A Missed Opportunity for Antimicrobial Stewardship.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia.JAMA internal medicine · 2020Article
- Potential Impact of Hospital-acquired Pneumonia Guidelines on Empiric Antibiotics. An Evaluation of 113 Veterans Affairs Medical Centers.Annals of the American Thoracic Society · 2019Article
- Microbiology Comment Nudge Improves Pneumonia Prescribing.Open forum infectious diseases · 2018Article
- Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2017Article
- Outcomes Associated With Antimicrobial De-escalation of Treatment for Pneumonia Within the Veterans Healthcare Administration.Open forum infectious diseases · 2017Article
- Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study.Critical care research and practice · 2016Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesThe objective of this study was to measure quantitatively antimicrobial de-escalation utilizing electronic medication administration data based on the spectrum of activity for antimicrobial therapy (i.e. spectrum score) to identify variables associated with de-escalation in a nationwide healthcare system.
methodsA retrospective cohort study of patients hospitalized for healthcare-associated pneumonia was conducted in Veterans Affairs Medical Centers (n = 119). Patients hospitalized for healthcare-associated pneumonia on acute-care wards between 5 and 14 days who received antimicrobials for ≥ 3 days during calendar years 2008-11 were evaluated. The spectrum score method was applied at the patient level to measure de-escalation on day 4 of hospitalization. De-escalation was expressed in aggregate and facility-level proportions. Logistic regression was used to assess variables associated with de-escalation. ORs with 95% CIs were reported.
resultsAmong 9319 patients, the de-escalation proportion was 28.3% (95% CI 27.4-29.2), which varied 6-fold across facilities [median (IQR) facility-level de-escalation proportion 29.1% (95% CI 21.7-35.6)]. Variables associated with de-escalation included initial broad-spectrum therapy (OR 1.5, 95% CI 1.4-1.5 for each 10% increase in spectrum), collection of respiratory tract cultures (OR 1.1, 95% CI 1.0-1.2) and care in higher complexity facilities (OR 1.3, 95% CI 1.1-1.6). Respiratory tract cultures were collected from 35.3% (95% CI 32.7-37.7) of patients.
conclusionsDe-escalation of antimicrobial therapy was limited and varied substantially across facilities. De-escalation was associated with respiratory tract culture collection and treatment in a high complexity-level facility.
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