title: [A study of the effectiveness and cost of de-escalation therapy for severe lower airway infection in a respiratory intensive care unit].
abstract: OBJECTIVE
  To evaluate the effectiveness of de-escalation therapy (DET) in patients with severe lower airway infection in the respiratory care unit.
  
  
  METHODS
  Sixty-seven cases of severe lower airway infection (SLAI) were divided into two groups: a DET group (n = 29), and a non-DET group (NDET, n = 38). Samples of lower airway secretions were collected by blinded protected specimen brush for culture and Gram stain. The clinical data were compared between the DET group and the NDET group, including the time of mechanical ventilation, time of stay in hospital, APACHE-II score, treatment responses and outcome, cost of antibiotics and total cost in the hospital.
  
  
  RESULTS
  There were significant differences in time in hospital (14 +/- 8; 19 +/- 12), the time of mechanical ventilation (22 +/- 16; 32 +/- 16) and the total cost in-hospital (52 871 +/- 54 457; 82 913 +/- 49 564. t = 2.195, 2.449, 2.354, all P < 0.05), while there was no significant difference in the cost on antibiotics between the DET group (7896 +/- 4718) and the NDET group (8490 +/- 5786. t = 0.449, P > 0.05). The mortality and inappropriate antibiotic therapy rate of the DET group (13.8%, 27.6%) were lower than those of the NDET group (36.8%, 60.5%; chi(2) = 4.45, 7.18, all P < 0.05).
  
  
  CONCLUSIONS
  The mortality of SLAI was significantly decreased by DET. DET also led to shorter time of mechanical ventilation, shorter course of therapy and less total cost of therapy.
authors.affiliation: Department of Respiratory Medicine, Second Hospital Hebei Medical University, Hebei 050000, China.
authors.forename: Xi-xin
authors.initials: XX
authors.lastname: Yan
authors.forename: Li-juan
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Cai
authors.forename: Shu-hong
authors.initials: SH
authors.lastname: Liu
authors.forename: Hong-lin
authors.initials: HL
authors.lastname: Li
authors.forename: Fu-wen
authors.initials: FW
authors.lastname: Shi
authors.forename: Ning
authors.initials: N
authors.lastname: Song
authors.forename: Yu-zhen
authors.initials: YZ
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents