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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
dc.creator | Palacios-Baena, ZR | es |
dc.creator | Delgado-Valverde, Mercedes | es |
dc.creator | Mendez, AV | es |
dc.creator | Almirante, Benito | es |
dc.creator | Gomez-Zorrilla, S | es |
dc.creator | Borrell, N | es |
dc.creator | Corzo Delgado, Juan Enrique | es |
dc.creator | Pascual Hernández, Álvaro | es |
dc.creator | Rodríguez-Baño, Jesús | es |
dc.creator | Cueto López, Marina de | es |
dc.creator | Lepe Jiménez, José Antonio | es |
dc.creator | Cisneros, José Miguel | es |
dc.creator | Lara, R | es |
dc.date.accessioned | 2024-06-19T11:42:55Z | |
dc.date.available | 2024-06-19T11:42:55Z | |
dc.date.issued | 2019 | |
dc.identifier.citation | 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. | |
dc.identifier.issn | 1058-4838 | es |
dc.identifier.issn | 1537-6591 | es |
dc.identifier.uri | https://hdl.handle.net/11441/160685 | |
dc.description.abstract | 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. | es |
dc.format | application/pdf | es |
dc.format.extent | 8 p. | es |
dc.language.iso | eng | es |
dc.publisher | Oxford University Press | es |
dc.relation.ispartof | Clinical Infectious Diseases, 69 (6), 956-962. | |
dc.subject | De-escalation | es |
dc.subject | Streamlining | es |
dc.subject | Enterobacteriaceae | es |
dc.subject | Bloodstream infections | es |
dc.subject | Mortality | es |
dc.title | Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort | es |
dc.type | info:eu-repo/semantics/article | es |
dc.type.version | info:eu-repo/semantics/acceptedVersion | es |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Microbiología | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Medicina | es |
dc.relation.projectID | REIPI RD16/0016/0001 | es |
dc.relation.projectID | REIPI RD16/0016/0003 | es |
dc.relation.projectID | REIPI RD16/0016/0004 | es |
dc.relation.projectID | REIPI RD16/0016/0005 | es |
dc.relation.projectID | REIPI RD16/0016/0006 | es |
dc.relation.projectID | REIPI RD16/0016/0007 | es |
dc.relation.projectID | REIPI RD16/0016/0009 | es |
dc.relation.projectID | REIPI RD16/0016/0011 | es |
dc.relation.projectID | REIPI RD16/0016/0013 | es |
dc.relation.projectID | REIPI RD16/0016/0016 | es |
dc.relation.publisherversion | https://academic.oup.com/cid/article/69/6/956/5236616 | es |
dc.identifier.doi | 10.1093/cid/ciy1032 | es |
dc.journaltitle | Clinical Infectious Diseases | es |
dc.publication.volumen | 69 | es |
dc.publication.issue | 6 | es |
dc.publication.initialPage | 956 | es |
dc.publication.endPage | 962 | es |
dc.contributor.funder | European Development Regional Fund "A Way to Achieve Europe," Spanish Network for Research in Infectious Diseases | es |
dc.description.awardwinning | Premio Mensual Publicación Científica Destacada de la US. Facultad de Medicina | |
dc.description.awardwinning | Premio Anual Publicación Científica Destacada de la US. Facultad de Medicina |
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