Antimicrobials & Drug Resistance | Bacterial Infections | Health Systems & Services Research | Clinical Nutrition
De-escalation of antimicrobial therapy in Gram negative sepsis: Easier said than done?
L Phee, DW Wareham*
*Corresponding author: DW Wareham
Department of Medical Microbiology, Barts and The London NHS Trust, London, UK
Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and The London, Queen Marys School of Medicine and Dentistry, London, UK
F1000Posters 2011, 2: 327 (poster) [ENGLISH]
Poster [134.11 KB]
Presented at
31st International Symposium on Intensive Care and Emergency Medicine ISICEM 2011,
20 - 23 Mar 2011, P219
Surviving sepsis guidelines have reiterated the need for timely use of appropriate empirical antimicrobials as well as the importance of de-escalation of therapy when the causative agent has been identified.
We conducted a prospective audit in our teaching hospital to examine our local practice, as well as analyse the clinical outcomes of patients whose therapies adhered to guidelines against those that did not.
We found that de-escalation in a timely fashion was not the prevailing practice in the majority of gram negative bacteraemia cases we analysed, and as a result these patients (non-deescalated group) had a higher incidence of diarrhoea and multidrug-resistant organism colonization. Mortality rate was also observed to be higher in the non-deescalated group, but the difference was marginal. Many factors underlie this deviation from recommended guidelines, including worsening clinical condition, reported penicillin allergy as well as multiple co-morbidities.
We are currently further analyzing our data to investigate the reasons for deviation in guidelines, to give us a better picture as to whether strict adherence to this particular aspect of the surviving sepsis guidelines has an impact, if any, on patient care.
No relevant conflicts of interest declared.
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