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Table 3 Anti-infective regimens in patients with or without de-escalation and clinical characteristics at day 3

From: Characteristics and outcomes of anti-infective de-escalation during health care-associated intra-abdominal infections

 

De-escalation (n = 110)

No de-escalation (n = 96)

Escalation (n = 65)

No change (n = 31)

Empiric antibiotic therapy

 Monotherapy, n (%)

13 (12)

32 (33)a

20 (31)

12 (29)

 Combination of two drugs, n (%)

40 (36)

34 (35)

26 (40)

8 (26)

 Combination of three drugs or more, n (%)

57 (49)

30 (33)b

19 (29)

11 (35)

 Carbapenem, n (%)

35 (32)

15 (16)a

10 (15)

5 (16)

 Piperacillin-tazobactam, n (%)

67 (61)

60 (63)

40 (62)

20 (65)

 Vancomycin, n (%)

57 (52)

23 (24)a

15 (23)

8 (26)

 Aminoglycosides, n (%)

59 (54)

33 (34)a

27 (42)

6 (19)b

 Fluoroquinolones, n (%)

6 (5)

11 (11)

10 (15)

1 (3)

Antifungal therapy, n (%)

47 (43)

23 (24)a

11 (17)

12 (39)b

 Azoles, n (%)

41 (37)

20 (21)a

9 (14)

11 (35)b

Adequate empiric therapy, n (%)

100 (91)

37 (39)a

9 (14)

28 (90)c

Reevaluation of antibiotic therapy

 Discontinuation of carbapenemsd, n (%)

27/35 (77)

4/15 (27)

4/10 (40)

–

 Discontinuation of piperacillin-tazobactamd, n (%)

50/67 (75)

25/60 (42)

25/40 (63)

–

 Discontinuation of vancomycind, n (%)

46/57 (81)

6/23 (26)

6/15 (40)

–

 Discontinuation of aminoglycosidesd, n (%)

54/59 (92)

21/33 (64)

21/27 (78)

–

 Discontinuation of fluoroquinolonesd, n (%)

2/6 (33)

6/11 (55)

6/10 (60)

–

 Discontinuation of antifungal agent d, n (%)

23/47 (49)

4/23 (17)

4/11 (36)

–

 Withdrawal of at least one agent, n (%)

110 (100)

42 (47)a

42 (65)

–

 Narrowing spectrum, n (%)

74 (67)

18 (19)a

18 (28)

–

 Switch to monotherapy, n (%)

54 (49)

7 (7)a

7 (11)

–

 Interruption of unnecessary agent, n (%)

78 (71)

20 (21)a

20 (31)

–

Clinical changes between days 0 and 3

 Changes in SOFA score, median (IQR)

−2 (−4 to -1)

−2 (−4 to 0)

−2 (−4 to 0)

−2 (−3 to 0)

 Decreased SOFA score, n (%)

69 (63)

57 (59)

38 (58)

19 (61)

 Decreased temperature, n (%)

69 (63)

64 (67)

41 (63)

23 (74)

 Decreased WBC, n (%)

38 (35)

32 (33)

23 (35)

9 (29)

 Clinical improvement at day 3, n (%)

17 (15)

18 (19)

14 (22)

4 (13)

  1. IQR interquartile range, SOFA Sequential Organ Failure Assessment, WBC white blood cell count
  2. Among those without de-escalation, the results were analyzed in terms of subsequent antibiotic escalation or no change. Results are expressed as number and proportion of the total number of patients
  3. a p < 0.01 versus de-escalation
  4. b p < 0.05 versus de-escalation
  5. c p < 0.01 versus escalation therapy
  6. dProportions are expressed as the number of discontinuations of the drug to the total number of patients empirically receiving this class of drug
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Critical Care

ISSN: 1364-8535