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Table 5 Clinical presentation at day 7 of empiric therapy and outcome in patients with or without de-escalation

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)

Definitive anti-infective therapy

 Monotherapy, n (%)

64 (58)

21 (22)

9 (14)

12(29)a

 Combination of two drugs, n (%)

33 (30)

39 (41)

31 (48)

8 (26)b

 Combination of three drugs or more, n (%)

13 (12)

36 (38)

25 (38)

11 (35)

 Use of carbapenems, n (%)

5 (5)

23 (24)a

18 (28)

5 (16)

 Use of piperacillin-tazobactam, n (%)

28 (25)

39 (41)b

19 (29)

20 (65)a

 Use of vancomycin, n (%)

11 (10)

41 (43)a

33 (51)

8 (26)b

 Use of antifungals, n (%)

29 (26)

43 (45)a

31 (48)

12 (39)

 Use of azoles, n (%)

28 (25)

39 (41)b

28 (43)

11 (35)

 Use of echinocandins, n (%)

1 (1)

3 (3)

3 (5)

–

 Duration of anti-infective therapy, days, median (IQR)

10 (10–14)

10 (10–14)

10 (10–14)

10 (10–14)

Clinical changes between days 3 and 7

 Number of cases at day 7

91

75

51

24

  Changes in SOFA scorec, median (IQR)

−1 (−3 to 0)

−2 (−4 to 0)

−2 (−4 to 0)

−2 (−4 to 0)

  Decreased SOFA scorec, n (%)

57 (63)

48 (64)

35 (54)

13 (42)

  Decreased temperaturec, n (%)

38 (42)

36 (48)

27 (42)

9 (29)

  Decreased WBCc, n (%)

31 (34)

17 (23)

12 (18)

5 (16)

  Clinical improvement at day 7c, n (%)

16 (18)

9 (12)

9 (14)

–

 Discharge between days 3 and 7, n (%)

20 (22)

15 (20)

10 (20)

5 (21)

 Death between days 3 and 7, n (%)

1 (1)

3 (4)

2 (4)

1 (4)

Medical complications

12 (12)

14 (16)

6 (10)

8 (29)

Surgical complications

26 (25)

21 (24)

10 (17)

11 (39)b

Reoperation, n (%)

38 (35)

35 (36)

19 (29)

16 (51)b

Time to reoperation, days, median (IQR)

6 (5–9)

6 (5–8)

5 (4–8)

7 (6–10)

Superinfection on subsequent reoperationd, n (%)

23 (61)

23 (66)

13 (68)

10 (63)

Emergence of MDR strainsd, n (%)

21 (55)

20 (57)

11 (58)

9 (56)

Emergence of ESBL Enterobacteriaceae d, n (%)

5 (13)

5 (14)

3 (16)

2 (13)

Emergence of MDR NFGNBd, n (%)

9 (24)

5 (14)

2 (11)

3 (19)

Emergence of MRSAd, n (%)

9 (24)

8 (23)

6 (32)

2 (13)

Duration of mechanical ventilatione, days, median (IQR)

7 (3–13)

7 (3–11)

7 (2–10)

7 (3–15)

ICU length of staye, days, median (IQR)

12 (8–20)

12 (8–21)

12 (8–21)

14 (5–23)

Survival at day 28, n (%)

91 (83)

72 (75)

51 (78)

21 (68)

ICU mortality rate, n (%)

23 (21)

32 (33)b

18 (28)

14 (45)

Hospital mortality rate, n (%)

25 (23)

33 (34)

19 (29)

14 (45)

  1. ESBL extended-spectrum β-lactamase, ICU intensive care unit, IQR interquartile range, MDR multidrug-resistant, MRSA methicillin-resistant Staphylococcus aureus, NFGNB nonfermenting Gram-negative bacilli, 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
  3. a p < 0.01 versus escalation therapy
  4. b p < 0.05 versus escalation therapy
  5. cResults expressed as number of patients at day 7 in the same group
  6. dResults expressed as number of patients who underwent reoperation in the same group
  7. eResults calculated for ICU survivor patients
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Critical Care

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