PMID- 32276874
OWN - NLM
STAT- MEDLINE
DCOM- 20201207
LR  - 20201214
IS  - 1876-035X (Electronic)
IS  - 1876-0341 (Linking)
VI  - 13
IP  - 7
DP  - 2020 Jul
TI  - Impact of antibiotic de-escalation on hospitalized patients with urinary tract 
      infections: A retrospective cohort single center study.
PG  - 985-990
LID - S1876-0341(20)30404-4 [pii]
LID - 10.1016/j.jiph.2020.03.004 [doi]
AB  - BACKGROUND: Urinary tract infections (UTIs) can be caused by multiple 
      drug-resistant bacteria. Empirical broad-spectrum antibiotics help minimize the 
      risk of disease progression. Although antibiotic de-escalation is important to 
      reduce resistance, adverse drug effects, and costs, few studies have evaluated 
      the impact of antibiotic de-escalation on complicated UTIs in hospitalized 
      patients. METHODS: In this retrospective cohort single center observational study 
      conducted over a period of 1 year at Prince Sultan Military Medical City (PSMMC), 
      the rate of antibiotic de-escalation following reporting culture and sensitivity 
      results, hospital length of stay (LOS), and factors associated with antibiotic 
      de-escalation failure were determined. RESULTS: Ninety-one patients were enrolled 
      in this study. Baseline characteristics were comparable between groups. The rate 
      of successful de-escalation was 29.7% (27 patients) while 70.3% (64 patients) 
      failed to experience de-escalation. The median hospital LOS was significantly 
      lower in successfully de-escalated patients, at 3 days interquartile range (IQR) 
      (2-6), while in the failed group it was 10 days IQR (6-21) (p<0.001). However, 
      the identified factor associated with failure was a multidrug-resistant (MDR) 
      pathogen that was significantly higher in the failed group than in the successful 
      group: 38 patients (59.4%) versus 6 patients (22.2%; p<0.001), respectively. 
      CONCLUSION: Antibiotic de-escalation is an essential antimicrobial stewardship 
      strategy. The findings of this study showed that de-escalation was associated 
      with better patient outcomes (i.e., reduced hospital LOS) in patients admitted 
      due to UTIs. In this study's site hospital, there is a potential for improving 
      the current de-escalation rate. MDR pathogens were the only significant reason 
      identified for de-escalation failure. Further data are needed on the large scale 
      to evaluate reasons for de-escalation failure.
CI  - Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
FAU - Alshareef, Hanan
AU  - Alshareef H
AD  - Department of Pharmacy Practice, College of Pharmacy, University of Tabuk, Tabuk, 
      Saudi Arabia; Department of Pharmacy, Prince Sultan Military Medical City, 
      Riyadh, Saudi Arabia. Electronic address: halsharef@ut.edu.sa.
FAU - Alfahad, Wafa
AU  - Alfahad W
AD  - Department of Pharmacy, Prince Sultan Military Medical City, Riyadh, Saudi 
      Arabia.
FAU - Albaadani, Abeer
AU  - Albaadani A
AD  - Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi 
      Arabia.
FAU - Alyazid, Huda
AU  - Alyazid H
AD  - Department of Pharmacy, Prince Sultan Military Medical City, Riyadh, Saudi 
      Arabia.
FAU - Talib, Ruba Bin
AU  - Talib RB
AD  - Department of Pharmacy, Prince Sultan Military Medical City, Riyadh, Saudi 
      Arabia.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20200408
PL  - England
TA  - J Infect Public Health
JT  - Journal of infection and public health
JID - 101487384
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - *Antimicrobial Stewardship
MH  - Cohort Studies
MH  - Drug Resistance, Multiple, Bacterial
MH  - Female
MH  - *Hospitalization
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Urinary Tract Infections/*drug therapy/microbiology
OTO - NOTNLM
OT  - Antibiotic de-escalation
OT  - Multidrug-resistant pathogen
OT  - Urinary tract infections
EDAT- 2020/04/12 06:00
MHDA- 2020/12/15 06:00
CRDT- 2020/04/12 06:00
PHST- 2019/12/31 00:00 [received]
PHST- 2020/02/27 00:00 [revised]
PHST- 2020/03/08 00:00 [accepted]
PHST- 2020/04/12 06:00 [pubmed]
PHST- 2020/12/15 06:00 [medline]
PHST- 2020/04/12 06:00 [entrez]
AID - S1876-0341(20)30404-4 [pii]
AID - 10.1016/j.jiph.2020.03.004 [doi]
PST - ppublish
SO  - J Infect Public Health. 2020 Jul;13(7):985-990. doi: 10.1016/j.jiph.2020.03.004. 
      Epub 2020 Apr 8.