Physicians Compliance with Antimicrobialsâ€™ De-escalation in Intensive Care Units in Jordan
Keywords:De-escalation, Broad-spectrum antimicrobials, physiciansâ€™ behavior, prudent antimicrobialsâ€™ use, bacterial resistance.
To evaluate physiciansâ€™ behavior toward de-escalation of broad-spectrum antimicrobials to narrow-spectrum agents for patients when opportunities loom.
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.
One hundred and nineteen patientsâ€™ charts were reviewed. There was 69 (58%) male and 50 (42%) female with mean ages of 59.3 and 68.6 years respectively.Â Eight (6.7%) patients were de-escalated to narrower spectrum antimicrobials. None of: APACHE 2 score, comorbidities, patientsâ€™ 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.
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.
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