Safety of antimicrobial de-escalation for culture-negative severe pneumonia

Kwon Byoung Soo; Choi Sang Ho; Koh Younsuck; Huh Jin-Won; Hong Sang-Bum; Lim Chae-Man

doi:10.1016/j.jcrc.2019.06.026

Safety of antimicrobial de-escalation for culture-negative severe pneumonia

J Crit Care. 2019 Dec:54:14-19. doi: 10.1016/j.jcrc.2019.06.026. Epub 2019 Jun 28.

Authors

Kwon Byoung Soo¹, Choi Sang Ho², Koh Younsuck³, Huh Jin-Won³, Hong Sang-Bum³, Lim Chae-Man⁴

Affiliations

¹ Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
² Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: cmlim@amc.seoul.kr.

Abstract

Purpose: This study investigated the outcomes of antimicrobial de-escalation (ADE) based on mortality and the incidence of multi-drug resistant (MDR) pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis and septic shock.

Materials and methods: We retrospectively analyzed patients diagnosed with severe pneumonia requiring intensive care unit (ICU) admission and possessing negative microbiological culture results at a tertiary referral hospital in South Korea from March 2008 to July 2018.

Results: We identified 107 patients with culture-negative pneumonia. The Acute Physiologic and Chronic Health Evaluation (APACHE) II and Sepsis-related Organ Failure Assessment (SOFA) mean scores were 20.3 ± 8.6 and 9.6 ± 3.3, respectively. Among the patients, 40 (37.4%) underwent ADE. The APACHE II, SOFA, and follow-up SOFA scores did not differ significantly between the groups, and no differences were found in ICU mortality and MDR pathogen occurrence (27.5% vs 41.8%, P = .137 and 15.0% vs 16.9% P = .794, respectively).

Conclusions: We observed similar ICU mortality and MDR pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis/shock regardless of whether they received ADE. Additionally, ADE lowered the antimicrobial burden.

Keywords: Antimicrobial; Culture negative; De-escalation; Mortality; Multi-drug resistance; Pneumonia.

MeSH terms

APACHE
Adult
Aged
Anti-Bacterial Agents / therapeutic use*
Drug Resistance, Microbial*
Female
Hospitalization
Humans
Intensive Care Units
Male
Middle Aged
Organ Dysfunction Scores*
Patient Safety
Pneumonia / drug therapy*
Republic of Korea
Retrospective Studies
Sepsis / mortality
Shock, Septic / mortality
Treatment Outcome

Substances

Anti-Bacterial Agents