A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia
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Background Antibiotic de-escalation is an important strategy to conserve the effectiveness of broad-spectrum antibiotics. However, the outcome of this strategy for the treatment of ventilator-associated pneumonia (VAP) has not been widely studied in developing countries. Objectives To evaluate the outcome on intensive care unit (ICU) mortality, 28 days mortality, and length of ICU stay among VAP patients who receive de-escalation therapy. Setting This study was conducted in an ICU of a Malaysian public hospital. Method The electronic medical records of patients who developed VAP in the ICU were retrieved and relevant data was collected. Records of antibiotic prescriptions were also reviewed to collect the details of changes to antibiotic therapy (de-escalation). Main outcome measure Impact of antibiotic de-escalation on mortality. Results The mean age of the 108 patients was 46.2 ± 18.2 years; the majority being males (80%). The antibiotic de-escalation rate was about 30%. Out of this, 84% involved a change from broad to narrow-spectrum antibiotics and the remaining, withdrawal of one or more antibiotics. ICU mortality was 23% while 28 days mortality was 37%. There was no statistically significant difference in mortality rate, survival probability and the mean length of ICU stay between the de-escalation and the non-de-escalation group. However, patients with Simplified Acute Physiology Score II of ≥50 were significantly associated with ICU mortality and 28 days mortality. Conclusions In VAP patients, antibiotic de-escalation provides an opportunity to promote the judicious use of antibiotics without affecting the clinical outcomes.
KeywordsAntibiotic de-escalation Critically-ill patients Intensive care unit Malaysia Ventilator-associated pneumonia
The authors wish to thank the Director-General of Health, Malaysia for the permission to publish this paper. We are grateful to Dr. Shanthi Ratnam, Consultant Intensivist of Sungai Buloh Hospital, Dr. Suresh Kumar, Consultant Infectious Disease of Sungai Buloh Hospital and Dr. Kalaiarasu Peariasamy, Senior Consultant and Head of Paediatric Dentistry of Sungai Buloh Hospital and Siti Salwa Mohd Latib for their support towards this research project. We are also thankful to Faculty of Medicine of the University of Malaya and, Clinical Research Centre and Pharmacy Department of Sungai Buloh Hospital for their technical support.
Conflicts of interest
The authors declare no conflict of interest.
- 20.Kim JW, Chung J, Choi SH, Jang HJ, Hong SB, Lim CM, et al. Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial. Crit Care. 2012;16:28–36.CrossRefGoogle Scholar
- 28.Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.CrossRefPubMedGoogle Scholar
- 34.Bajpai S, Karnad DR. De-escalation of antibiotics in nosocomial pneumonia in an Indian intensive care unit. Int J Med Med Sci. 2010;2:148–52.Google Scholar
- 48.Boyce JM, Pop OF, Abreu-Lanfranco O, Hung WY, Fisher A, Karjoo A, et al. A trial of discontinuation of empiric vancomycin therapy in patients with suspected methicillin-resistant staphylococcus aureus health care-associated pneumonia. Antimicrob Agents Chemother. 2013;57:1163–8.CrossRefPubMedPubMedCentralGoogle Scholar