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Published on:January 2017
Indian Journal of Pharmaceutical Education and Research, 2017; 51(1):144-149
Original Article | doi:10.5530/ijper.51.1.19

Antibiotic De-escalation Therapy in Neurosurgical Patients with Ventilator-Associated Pneumonia in Intensive Care Unit: A Retrospective Observational Study


Authors and affiliation (s):

Rahela Ambaras Khan, Zoriah Aziz*

Department of Pharmacy, Faculty of Medicine, University of Malaya- Kuala Lumpur, MALAYSIA.

Abstract:

Context: Antibiotic de-escalation practice is gaining interest in the intensive care units (ICU). However, there is limited evidence to support this approach in neurosurgical patients with Ventilator-Associated Pneumonia (VAP) in ICU. Aims: This study examined the practice of antibiotic de-escalation in neurosurgical patients with VAP in ICU and its impact on mortality. Settings and Design: Retrospective cross-sectional study conducted in an ICU of a public hospital in Malaysia. Methods and Material: The electronic medical records of the patients diagnosed with VAP in the ICU were retrieved and relevant data was collected for analysis. Statistical analysis used: Mann-Whitney U-test and Chi- Square Test were used to compare the differences of continuous and categorical data while Logistic Regression and Cox Regression were used to estimate the influence of de-escalation on mortality. Results: Of the 125 VAP patients identified, only 53 (42.4%) were neurosurgical patients. The mean age of these patients was 40.5±15.3 years old. The patients mainly had late-onset VAP. The most common organisms identified included Pseudomonas aeruginosa (19.6%) and Acinetobacter Multidrug-Resistant Organisms (17.9%) while the most commonly used empirical antibiotic was Cefepime (32%). The proportion of patients with antibiotic de-escalation (10 out of 53) was statistically lower than patients without antibiotic de-escalation (43 out of 53). There was no statistically significant difference in ICU-mortality between the de-escalation (2 out of 10) and non-deescalation groups (6 out of 43). Similarly, for the 28-day mortality and survival analysis, no significant difference was found between the two groups. Conclusions: Antibiotic de-escalation practice in neurosurgical patients with VAP in ICU was not associated with a deleterious effect on survival.

Key words: Antibiotic de-escalation, Ventilator-associated pneumonia, Neurosurgical, Critical care, Critically-ill patients.

Key Messages: Despite the potential benefit of antibiotic de-escalation, this practice remains low among the neurosurgical population with ventilator-associated pneumonia in the intensive care unit. As this practice was not associated with an excess in mortality, it should be cultivated among critically-ill neurosurgical patients in intensive care unit.

 

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The Official Journal of Association of Pharmaceutical Teachers of India (APTI)
(Registered under Registration of Societies Act XXI of 1860 No. 122 of 1966-1967, Lucknow)

Indian Journal of Pharmaceutical Education and Research (IJPER) [ISSN-0019-5464] is the official journal of Association of Pharmaceutical Teachers of India (APTI) and is being published since 1967.

DOI HISTORY

IJPER uses reference linking service using Digital Object Identifiers (DOI) by Crossref. Articles from the year 2013 are being assigned DOIs for its permanent URLs