- Poster presentation
- Open Access
De-escalation practice pattern in an Indian intensive care unit
© BioMed Central Ltd. 2010
- Published: 1 March 2010
- Practice Pattern
- Tertiary Care Hospital
- Prevalent Practice
- Susceptible Organism
Antibiotic de-escalation is thought to be beneficial by reducing the selection pressure for resistance. This study was carried out to identify variables that influence de-escalation practices.
Seven hundred and seventy-eight patients were included, of whom cultures were positive in 551 (70.8%) and negative in 227 (29.2%) cases. In 350 (44.9%) patients, neither escalation nor de-escalation of therapy was done. Overall escalation of therapy occurred in 192 (24.7%) patients and de-escalation in 236 (30.3%). The mortality rate was lowest among patients in whom therapy was de-escalated (8.9%) compared with categories of no change (14.2%) or escalation (23.4%). De-escalation occurred more frequently among patients in whom no pathogen was isolated (45.8%) compared with culture-positive cases (23.9%) and in 18.3% of patients with growth of drug-resistant pathogens, compared with 38.9% of patients with susceptible pathogens. De-escalation occurred most frequently where an antibiotic having only Gram-positive coverage was included in the initial empiric therapy (60.3%), and in cases where third-generation cephalosporin was the initial empiric therapy (54.4%).
This study highlights no change of therapy as the most prevalent practice pattern of antibiotic use. Mortality remained low in patients in whom therapy was de-escalated. Variables favoring de-escalation practices were non-isolation of pathogen, growth of susceptible organisms, and stopping of Gram-positive coverage.