Artículo
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Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort
Autor/es | Palacios-Baena, ZR
Delgado-Valverde, Mercedes Mendez, AV Almirante, Benito Gomez-Zorrilla, S Borrell, N Corzo Delgado, Juan Enrique ![]() ![]() ![]() ![]() ![]() ![]() Pascual Hernández, Álvaro ![]() ![]() ![]() ![]() ![]() ![]() ![]() Rodríguez-Baño, Jesús ![]() ![]() ![]() ![]() ![]() ![]() ![]() Cueto López, Marina de ![]() ![]() ![]() ![]() ![]() ![]() Lepe Jiménez, José Antonio ![]() ![]() ![]() ![]() ![]() ![]() Cisneros, José Miguel ![]() ![]() ![]() ![]() ![]() ![]() ![]() Lara, R |
Departamento | Universidad de Sevilla. Departamento de Microbiología Universidad de Sevilla. Departamento de Medicina |
Fecha de publicación | 2019 |
Fecha de depósito | 2024-06-19 |
Publicado en |
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Premios | Premio Mensual Publicación Científica Destacada de la US. Facultad de Medicina Premio Anual Publicación Científica Destacada de la US. Facultad de Medicina |
Resumen | Background
More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate ... Background More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome. |
Agencias financiadoras | European Development Regional Fund "A Way to Achieve Europe," Spanish Network for Research in Infectious Diseases |
Identificador del proyecto | REIPI RD16/0016/0001
![]() REIPI RD16/0016/0003 ![]() REIPI RD16/0016/0004 ![]() REIPI RD16/0016/0005 ![]() REIPI RD16/0016/0006 ![]() REIPI RD16/0016/0007 ![]() REIPI RD16/0016/0009 ![]() REIPI RD16/0016/0011 ![]() REIPI RD16/0016/0013 ![]() REIPI RD16/0016/0016 ![]() |
Cita | Palacios-Baena, Z., Delgado-Valverde, M., Mendez, A., Almirante, B., Gomez-Zorrilla, S., Borrell, N.,...,Lara, R. (2019). Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort. Clinical Infectious Diseases, 69 (6), 956-962. https://doi.org/10.1093/cid/ciy1032. |
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