lunes, 19 de agosto de 2013

Physicians compliance with antimicrobials’ de-escalation in intensive care units in jordan

Background: To evaluate physicians’ behavior toward antimicrobials de-escalation for their patients should an opportunity come into view. Methods: A prospective observational study held in three hospitals. Data were obtained prospectively for ICU patients with the diagnosis of sepsis i.e. systemic sepsis of any source, multi-organ dysfunction syndrome, and septic shock and were started on broad-spectrum antimicrobial agents (BSA). Failure to de-escalate was considered if a known 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 were followed; their 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 II 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 did not de-escalate when it ought to be done. The concept of de-escalation has to be stressed upon widely among treating physicians

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