Physicians Compliance with Antimicrobials’ De-escalation in Intensive Care Units in Jordan

Authors

  • Jamal Ahmad Wadi Jordan Hospital and medical Center 29 Adeeb Wahba Street Amman - Jordan 11118
  • Sahar Al Shair
  • Waseem Abu Ashour
  • Mohammad Rabi
  • Haifa Petro
  • Amani Romman
  • Yaseen Alastal
  • Rula Rashed
  • Gheida Melhem

Keywords:

De-escalation, Broad-spectrum antimicrobials, physicians’ behavior, prudent antimicrobials’ use, bacterial resistance.

Abstract

Background

To evaluate physicians’ behavior toward de-escalation of broad-spectrum antimicrobials to narrow-spectrum agents for patients when opportunities loom.

Methods

A prospective study held in three hospitals. Data were obtained prospectively for ICU patients with the diagnosis of severe infections i.e. severe systemic sepsis, multi-organ dysfunction syndrome and septic shock, and were started on BSA. Failure to de-escalate was considered if culture was available and was susceptible to a narrower antimicrobial agent; hitherto the treating physician did not de-escalate. Excluded from the study patients who were not started on BSA, were on antimicrobial prophylaxis or there was no clear indication for starting BSA, also patients whom their microbiological diagnoses were not available or the pathogen was only susceptible to the initially started BSA.

 

Results

One hundred and nineteen patients’ charts were reviewed. There was 69 (58%) male and 50 (42%) female with mean ages of 59.3 and 68.6 years respectively.  Eight (6.7%) patients were de-escalated to narrower spectrum antimicrobials. None of: APACHE 2 score, comorbidities, patients’ outcome while on BSA, sepsis-predisposing clinical diagnosis and microbiological diagnosis significantly encourage physicians for de-escalation. The commonest initial antimicrobials used were Meropenem, Pipracillin/Tazobactam and Imipenem.

 

Conclusion

The majority of physicians are not de-escalating when it ought to be done. The concept of de-escalation has to be stressed upon widely among treating physicians.

Author Biography

Jamal Ahmad Wadi, Jordan Hospital and medical Center 29 Adeeb Wahba Street Amman - Jordan 11118

Chairman, Infection Prevention and Control Committee

Al Khalidi Medical Center

39 Ben Khaldoon Street

Amman - Jordan 11183

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Published

2013-04-03

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Articles