De-Escalation of Broad-Spectrum Antibiotics After Relevant Culture Reports in Medical Ward Patients Audit from A Tertiary Care Hospital in South India
Pharmaceutical Science-Medicine
DOI:
https://doi.org/10.22376/ijlpr.2023.13.1.P18-26Keywords:
Antimicrobial Stewardship, De-Escalation, Antibiotics, Antimicrobial Resistance, AMS, and Broad SpectrumAbstract
Prolonged and improper usage of antibiotics has been shown as a main reason for the emergence of multidrug-resistant pathogens.Antimicrobial stewardship (AMS) programs have been shown to reduce the antibiotics usage and the rate of emergence of resistance. De-escalation of antimicrobials is an important component of AMS. AMS programmes require regular auditing and feedback for proper implementation and continuous improvement. Hence we did this clinical audit with the main aim of estimating the de-escalation rates and identifying the possible reasons for non-de-escalation in our centre. Case sheets of the patients admitted between 1st October 2020 to 31st December 2020 were screened during discharge for data for de-escalation and reasons for non-de-escalation. Cefeprazone-sulbactum (32%) was commonly used empirical monotherapy in the audited period. De-escalation rate after positive culture reposts was 28%. Serious clinical illness (36%) was found to be the most common reason for non-de-escalation. De-escalation was not done in nearly 25% of eligible instances without a proper justification.
References
Fresán-Ruiz E, Izurieta-Pacheco AC, Girona-Alarcón M, de Carlos-Vicente JC, Bustinza-Arriortua A, Slocker-Barrio M et al. Antimicrobial stewardship improvement in pediatric intensive care units in Spain-what have we learned? Children (Basel). 2022 Jun 16;9(6):902. doi: 10.3390/children9060902, PMID 35740839, PMCID PMC9222022.
Moraes RB, Guillén JA, Zabaleta WJ, Borges FK. De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study. Rev Bras Ter Intensiva. 2016 Sep;28(3):315-22. doi: 10.5935/0103-507X.20160044. PMID 27626951, PMCID PMC5051191.
Ahmed SA, Kumar A, Sethi P, Kapil A, Pandey RM, Wig N. Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi. Natl Med J India. 2018 Sep-Oct;31(5):262-7. doi: 10.4103/0970-258X.261176, PMID 31267989.
Liu P, Ohl C, Johnson J, Williamson J, Beardsley J, Luther V. Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infect Dis. 2016 Dec 12;16(1):751. doi: 10.1186/s12879-016-2080-3, PMID 27955625, PMCID PMC5153830.
Alshareef H, Alfahad W, Albaadani A, Alyazid H, Talib RB. Impact of antibiotic de-escalation on hospitalized patients with urinary tract infections: A retrospective cohort single center study. J Infect Public Health. 2020 Jul;13(7):985-90. doi: 10.1016/j.jiph.2020.03.004. PMID 32276874.
Uda A, Ebisawa K, Sakon H, Kusuki M, Izuta R, Yahata M et al. Sustained Improvements in Antimicrobial Therapy and Clinical Outcomes following a Pharmacist-Led antimicrobial Stewardship Intervention: uncontrolled before-after study. J Clin Med. 2022 Jan 23;11(3):566. doi: 10.3390/jcm11030566, PMID 35160018, PMCID PMC8837014.
Viasus D, Vecino-Moreno M, De La Hoz JM, Carratalà J. Antibiotic stewardship in community-acquired pneumonia. Expert Rev Anti-Infect Ther. 2017 Apr;15(4):351-9. doi: 10.1080/14787210.2017.1274232. PMID 28002979.
Leone M, Roberts JA, Bassetti M, Bouglé A, Lavigne JP, Legrand M et al. Update in antibiotic therapy in intensive care unit: report from the 2019 Nîmes International Symposium. Anaesth Crit Care Pain Med. 2019 Dec;38(6):647-56. doi: 10.1016/j.accpm.2019.09.009. PMID 31606548.
de Carvalho FRT, Telles JP, Tuon FFB, Rabello Filho R, Caruso P, Correa TD. Antimicrobial stewardship programs: a review of strategies to avoid polymyxins and carbapenems misuse in low middle-income countries. Antibiotics (Basel). 2022 Mar 12;11(3):378. doi: 10.3390/antibiotics11030378, PMID 35326841, PMCID PMC8944697.
Alba Fernandez J, Del Pozo JL, Leiva J, Fernandez-Alonso M, Aquerreta I, Aldaz A et al. Impact of the acceptance of the recommendations made by a meropenem stewardship program in a University Hospital: A pilot study. Antibiotics (Basel). 2022 Mar 2;11(3):330. doi: 10.3390/antibiotics11030330, PMID 35326793, PMCID PMC8944864.
Verlinden A, Jansens H, Goossens H, Anguille S, Berneman ZN, Schroyens WA et al. Safety and efficacy of antibiotic de-escalation and discontinuation in high-risk hematological patients with febrile neutropenia: A single-center experience. Open Forum Infect Dis. 2022;9(3):ofab624. doi: 10.1093/ofid/ofab624, PMID 35146042, PMCID PMC8826378.
Tabah A, Lipman J, Barbier F, Buetti N, Timsit JF, On Behalf Of The Escmid Study Group For Infections In Critically Ill Patients-Esgcip. Use of antimicrobials for bloodstream infections in the Intensive Care Unit, a clinically oriented review. Antibiotics (Basel). 2022 Mar 8;11(3):362. doi: 10.3390/antibiotics11030362, PMID 35326825, PMCID PMC8944491.
Khan RA, Aziz Z. A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia. Int J Clin Pharm. 2017 Aug;39(4):906-12. doi: 10.1007/s11096-017-0499-2. PMID 28643112.
Contejean A, Abbara S, Chentouh R, Alviset S, Grignano E, Gastli N et al. Antimicrobial stewardship in high-risk febrile neutropenia patients. Antimicrob Resist Infect Control. 2022 Mar 26;11(1):52. doi: 10.1186/s13756-022-01084-0, PMID 35346373, PMCID PMC8961889.
El Masri M, Haddad N, Saad T, Rizk NA, Zakhour R, Kanj SS et al. Evaluation of carbapenem use before and after implementation of an antimicrobial stewardship-Led carbapenem-sparing strategy in a Lebanese tertiary hospital: A retrospective study. Front Cell Infect Microbiol. 2022 Mar 25;12:729491. doi: 10.3389/fcimb.2022.729491, PMID 35402313, PMCID PMC8990088.
Ibrahim A N, Makmor Bakry M, Mohd Tahir NA, Mohd Zaini NR, Mohamed Shah N. A Prospective Cohort Study of Factors Associated with Empiric Antibiotic De-escalation in Neonates Suspected with Early Onset Sepsis (EOS). Paediatr Drugs. 2020 Jun;22(3):321-330. doi: 10.1007/s40272-020-00388-1. PMID: 32185682; PMCID: PMC7222079.
Del Pozo JL. Stewardship in sepsis. Rev Esp Quimioter. 2019 Sep;32; Suppl 2;Suppl 2(Suppl 2):42-46:42-6. PMID 31475810, PMCID PMC6755359.
Silva CD, Silva Júnior M. Strategies for appropriate antibiotic use in intensive care unit. Einstein (São Paulo). 2015 Jul-Sep;13(3):448-53. doi: 10.1590/S1679-45082015RW3145. PMID 26132360, PMCID PMC4943795.
Tabah A, Lipman J, Barbier F, Buetti N, Timsit JF, On Behalf Of The Escmid Study Group For Infections In Critically Ill Patients-Esgcip. Use of antimicrobials for bloodstream infections in the Intensive Care Unit, a clinically oriented review. Antibiotics (Basel). 2022 Mar 8;11(3):362. doi: 10.3390/antibiotics11030362, PMID 35326825, PMCID PMC8944491.
D’Onofrio V, Meersman A, Magerman K, Waumans L, van Halem K, Cox JA et al. Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes. Int J Antimicrob Agents. 2021 Sep;58(3):106379. doi: 10.1016/j.ijantimicag.2021.106379. PMID 34161787.
Pérut V, Gauzit R, Kernéis S, Canouï E, Chedhomme FX, Batista R et al. Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation. Med Mal Infect. 2019 May;49(3):187-93. doi: 10.1016/j.medmal.2018.10.002. PMID 30420165.
De Bus L, Denys W, Catteeuw J, Gadeyne B, Vermeulen K, Boelens J et al. Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study. Intensive Care Med. 2016 Jun;42(6):1029-39. doi: 10.1007/s00134-016-4301-z. PMID 27025939.
Kumar A, Sahu M, Sahoo PR, Wig N. Under-explored dimensions of anti-microbial stewardship in India. J Assoc Physicians India. 2018 Dec;66(12):69-71. PMID 31313554.
Viasus D, Simonetti AF, Garcia-Vidal C, Niubó J, Dorca J, Carratalà J. Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia. J Antimicrob Chemother. 2017 Feb;72(2):547-53. doi: 10.1093/jac/dkw441. PMID 27798219.
Goebel MC, Trautner BW, Grigoryan L. The five Ds of outpatient antibiotic stewardship for urinary tract infections. Clin Microbiol Rev. 2021 Dec 15;34(4):e0000320. doi: 10.1128/CMR.00003-20. PMID 34431702, PMCID PMC8404614.
Khasawneh FA, Karim A, Mahmood T, Ahmed S, Jaffri SF, Tate ME et al. Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome. Infection. 2014 Oct;42(5):829-34. doi: 10.1007/s15010-014-0639-8. PMID 24874607.
Kim HJ, Na SW, Alodaini HA, Al-Dosary MA, Nandhakumari P, Dyona L. Prevalence of multidrug-resistant bacteria associated with polymicrobial infections. J Infect Public Health. 2021 Dec;14(12):1864-9. doi: 10.1016/j.jiph.2021.11.005. PMID 34801434.
Batoni G, Maisetta G, Esin S. Therapeutic potential of antimicrobial peptides in polymicrobial biofilm-associated infections. Int J Mol Sci. 2021 Jan 6;22(2):482. doi: 10.3390/ijms22020482, PMID 33418930, PMCID PMC7825036.
Wolfe JR, Bryant AM, Khoury JA. Impact of an automated antibiotic time-out alert on the de-escalation of broad-spectrum antibiotics at a large community teaching hospital. Infect Control Hosp Epidemiol. 2019 Nov;40(11):1287-9. doi: 10.1017/ice.2019.197. PMID 31436144.
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