ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. 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 20 papers, 2 of them syntheses that pooled it.
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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
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Rapid Diagnostic Tests and Antimicrobial Stewardship Programs for the Management of Bloodstream Infection: What Is Their Relative Contribution to Improving Clinical Outcomes? A Systematic Review and Network Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Pooled it
- The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis.The Korean journal of internal medicine · 2023Pooled it
- Trial
- Evaluation of appropriateness of meropenem treatment and outcomes among internal medicine patients in Thailand.BMC infectious diseases · 2026Article
- Assessing the feasibility of a platform trial for Gram negative bloodstream infections: results from the vanguard phase of BALANCE.BMJ open · 2025Article
- Antibiotic de-escalation patterns and outcomes in critically ill patients with suspected pneumonia as informed by bronchoalveolar lavage results.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Article
- Effects of Antibiotic De-Escalation on Outcomes in Severe Community-Acquired Pneumonia: An Inverse Propensity Score-Weighted Analysis.Antibiotics (Basel, Switzerland) · 2025Article
- Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission.Antimicrobial resistance and infection control · 2025Article
- 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
- Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji's National Hospital.Antibiotics (Basel, Switzerland) · 2025Article
- Article
- Weighing options: empiric antibiotic use and stewardship opportunities in critically ill patients with community-acquired pneumonia.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Culture-negative sepsis may be a different entity from culture-positive sepsis: a prospective nationwide multicenter cohort study.Critical care (London, England) · 2024Article
- Diagnostic and antibiotic use practices among COVID-19 and non-COVID-19 patients in the Indonesian National Referral Hospital.PloS one · 2024Article
- Article
- Effect of Broad-Spectrum Antibiotic De-escalation on Critically Ill Patient Outcomes: A Retrospective Cohort Study.Journal of epidemiology and global health · 2023Article
- Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures.Pharmacy (Basel, Switzerland) · 2023Article
- Assessment of Antibiotic De-escalation by Spectrum Score in Patients With Nosocomial Pneumonia: A Single-Center, Retrospective Cohort Study.Open forum infectious diseases · 2021Article
- Review
- Initial antimicrobial management of sepsis.Critical care (London, England) · 2021Review
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Funding
Abstract
backgroundFor patients at risk for multidrug-resistant organisms, IDSA/ATS guidelines recommend empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. Following negative cultures, the guidelines recommend antimicrobial de-escalation. We assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients with pneumonia with negative cultures.
methodsWe included adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. De-escalation was defined as stopping both empiric drugs on day 4 while continuing another antibiotic. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration (ICU transfer), length-of-stay (LOS), and costs. We also compared adjusted outcomes across hospital de-escalation rate quartiles.
resultsOf 14 170 patients, 1924 (13%) had both initial empiric drugs stopped by hospital day 4. Hospital de-escalation rates ranged from 2-35% and hospital de-escalation rate quartile was not significantly associated with outcomes. At hospitals in the top quartile of de-escalation, even among patients at lowest risk for mortality, the de-escalation rates were <50%. In propensity-adjusted analysis, patients with de-escalation had lower odds of subsequent transfer to ICU (adjusted odds ratio, .38; 95% CI, .18-.79), LOS (adjusted ratio of means, .76; .75-.78), and costs (.74; .72-.76).
conclusionsA minority of eligible patients with pneumonia had antibiotics de-escalated by hospital day 4 following negative cultures and de-escalation rates varied widely between hospitals. To adhere to recent guidelines will require substantial changes in practice.
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