title: Safety and feasibility of antibiotic de-escalation in bacteremic pneumonia.
abstract: BACKGROUND
  Antibiotic de-escalation is a potential strategy advocated to conserve the effectiveness of broad-spectrum antibiotics. The aim of this study was to examine the safety and feasibility of antibiotic de-escalation in patients admitted with bacteremic pneumonia.
  
  
  METHODS
  A retrospective chart review was done for patients with bacteremic pneumonia admitted to Northwest Texas Hospital in Amarillo, TX, USA, during 2008. Antibiotic de-escalation was defined as changing the empiric antibiotic regimen to a culture-directed single agent with a narrower spectrum than the original regimen.
  
  
  RESULTS
  Sixty-eight patients were admitted with bacteremic pneumonia. Eight patients were not eligible for de-escalation. Among the 60 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 27 cases (45.0%). Discharge to a long-term care facility predicted failure to de-escalate antibiotics, while an infectious diseases consultation was significantly associated with antibiotic de-escalation. The average daily cost of antibacterial therapy in the de-escalation group was $25.7 compared with $61.6 in the group where de-escalation was not implemented. The difference in mean length of hospital stay and mortality between the two groups was not statistically significant.
  
  
  CONCLUSIONS
  Antibiotic de-escalation is a safe management strategy but unfortunately is not widely adopted. Although bacterial resistance poses a significant threat and is rising, antimicrobial de-escalation has emerged as a potential intervention that can conserve the effectiveness of broad-spectrum antibiotics without compromising the patient's outcome. This practice is becoming important in the face of slow development of new anti-infective agents.
authors: Section of Infectious Diseases, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
authors: Faisal A
authors: FA
authors: Khasawneh
authors: Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
authors: Adnanul
authors: A
authors: Karim
authors: Department of Internal Medicine, Deaconess Hospital, Evansville, IN, USA.
authors: Tashfeen
authors: T
authors: Mahmood
authors: Section of Nephrology, Department of Internal Medicine, University of Oklahoma, Tulsa, OK, USA.
authors: Subhan
authors: S
authors: Ahmed
authors: Department of Internal Medicine, Deaconess Hospital, Evansville, IN, USA.
authors: Sayyed F
authors: SF
authors: Jaffri
authors: Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
authors: Mansoor
authors: M
authors: Mehmood
keywords: antibiotic de-escalation strategy; bacteremia; lung infection