रोगाणुरोधी एजेंटों का जर्नल

Safety and Clinical Outcomes of Antibiotic Deescalation as Part of Antimicrobial Stewardship (AMS) Program:A Retrospective Observational Descriptive Study in an Intensive Care Unit

Abstract

Ann Lisa Arulappen, Monica Danial and Joo Thye Cheng

Introduction: Antimicrobial resistance has been a global issue past many decades and mortality rate in regards to it is multiplying drastically every other day.
De-escalation of antibiotic therapy is a measure to overcome this issue before it is too late. Having said this, many measures have been enforced by the Ministry
of Health, Malaysia to actively cultivate the culture of antimicrobial stewardship including de-escalation of therapy among the clinicians.
Method: This was a retrospective study from October 2019 to October 2020 involving patients aged 18 years and above admitted to the intensive care unit for
ventilator support and started on broader spectrum of antibiotics subsequently de-escalated to narrower spectrum of antibiotics upon 72 hours review by the
AMS team. The multiple outcomes measured in this study are sepsis free after treatment, the survival upon discharge, readmission within 30 days and also cost
savings associated with the antibiotics only.
Results: A total of 32 patients were recruited and eligible to be part of this study. Among the 32 patients, 29 (90.6%) of them presented with sepsis upon
admission whereas 3 (9.4%) patients were sepsis free. Nevertheless, about 21 (65.6%) patients were sepsis free after being treated in ICU and remaining 11
(34.4%) were still treated as sepsis. Majority of the study population survived upon discharge precisely 22 patients (68.8%). All 22 patients had no history of
readmission within 30 days after being discharge. Only 1 patient died additionally post 30 days from the date of discharge accumulating the total number of
fatalities up to 11 (34.4%). The total cost savings was approximately 52.7% which is equivalent to MYR 5,174.47.
Conclusion: It can be concluded that de-escalation of antibiotics therapy is not associated with increased risk of mortality despite no positive culture even in
critically ill patients