Evidence map›Paper›PMID 40097937›Full record

ArticleBMC infectious diseases2025

Baseline predictors of antibiotics de-escalation from empirical therapies in an intensive care unit: a five-year retrospective study.

Ann Lisa Arulappen, Amer Hayat Khan, Monica Danial, Syed Shahzad Hasan, Ting Soo Chow, Nehad Jaser Ahmed, Chiau Ming Long

Abstract read
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Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Ann Lisa ArulappenDepartment of Pharmacy, Penang Hospital, Ministry of Health, George Town, Penang, Malaysia.
Amer Hayat KhanDiscipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Science Malaysia, Georgetown, Penang, Malaysia. dramer2006@gmail.com.
Monica DanialClinical Research Center, Seberang Jaya Hospital, Ministry of Health, Permatang Pauh, Penang, Malaysia.
Syed Shahzad HasanDepartment of Pharmacy, School of Applied Science, University of Huddersfield, Huddersfield, UK.
Ting Soo ChowDepartment of Medicine, Penang Hospital, Ministry of Health, Georgetwon, Penang, Malaysia.
Nehad Jaser AhmedDepartment of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia.
Chiau Ming LongSchool of Medical and Life Sciences, Sunway University, Sunway City, Selangor, Malaysia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe alarming rate of bacterial resistance has urged for vigorous antibiotic de-escalation cultures worldwide. However, the art of de-escalation remains challenging as most clinicians have the fear or stigma that antibiotic de-escalation is strongly associated with higher mortality. This study aimed to determine the factors strongly correlated with higher mortality rates after antibiotic de-escalation and possibly serve as a benchmark study for developing a validated antibiotic de-escalation tool in the near future.

methodThis retrospective study was conducted on patients hospitalized in a medical intensive care unit of a referral tertiary care center and subjected to antibiotics de-escalation over five years. Independent factors associated with mortality post antibiotics de-escalation were assessed. Various data were collected, including patient demographics, admission and discharge dates, a primary source of infection and free of infection status, choices of antibiotic used and de-escalation history, vital signs, data on X-ray changes, relevant laboratory investigations, microbiological culture history, mortality status, history of COVID-19 infection, presence of central line, number of vasopressors used, ventilator settings and respective SOFA scores.

resultsPrevalence of mortality among patients continued on broad-spectrum antibiotics empirically is remarkable. Through this study, it was found that the significant factors associated with mortality post antibiotic de-escalation were hospital-acquired infection (HAI) (Adjusted OR: 12.56; 95% CI: 2.88,54.98; p < 0.001), systolic blood pressure in mmHg (Adjusted OR: 0.08; 95% CI: 0.02,0.33; p < 0.001), heart rate in bpm (Adjusted OR: 0.12; 95% CI: 0.03,0.45; p:0.002), SOFA scores (Adjusted OR: 21.44; 95% CI: 3.55,129.52; p:0.001) and number of vasopressors (Adjusted OR: 38.46; 95% CI: 1.54,959.30; p:0.026).

conclusionDe-escalation of antibiotics is considerable as the identified significant factors serve as baseline predictors which would certainly be helpful especially during the decision-making process of antibiotic de-escalation among the clinicians. Therefore, antibiotics de-escalation is highly encouraged to reduce the mortality risks.

Indexed as

Anti-Bacterial AgentsBacterial InfectionsIntensive Care UnitsAdultAgedAged, 80 and overCOVID-19FemaleHospital MortalityHumansMaleMiddle AgedRetrospective StudiesSARS-CoV-2Tertiary Care CentersAnti-Bacterial AgentsAntibioticsDe-escalationFactorsMortalityRetrospective analysis

Identifiers

PMID40097937
PMCPMC11912597

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.