title: Impact of antimicrobial strategies on clinical outcomes of adults with septic shock and community-onset Enterobacteriaceae bacteremia: de-escalation is beneficial.
abstract: To investigate the clinical outcomes of patients with septic shock related to community-onset monomicrobial Enterobacteriaceae (CoME) bacteremia as categorized by the strategy of antimicrobial therapy, a retrospective and observational study was conducted. Clinical information on the patients was obtained from medical records. Antibiotic regimens were ranked according to their activity spectrum against Enterobacteriaceae (category IV, highest; I, lowest). De-escalation was defined as a switch to a category with a narrower spectrum of coverage within 5days after the bacteremic onset. Of the 189 eligible patients, 86 (45.5%) patients received de-escalation antibiotic therapy, and most (48, 55.8%) of the patients were empirically treated first with a category IV antibiotic. In a multivariate analysis for 28-day mortality, of several independent predictors, the de-escalation strategy was protective (odds ratio, 0.37; P=0.04). In conclusion, for patients with CoME bacteremia and available susceptibility data, de-escalation of antimicrobial therapy was beneficial for improving clinical outcome.
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Ching-Chi
authors: CC
authors: Lee
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Nan-Yao
authors: NY
authors: Lee
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Po-Lin
authors: PL
authors: Chen
authors: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Ming-Yuan
authors: MY
authors: Hong
authors: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Tsung-Yu
authors: TY
authors: Chan
authors: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
authors: Chih-Hsien
authors: CH
authors: Chi
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors: Wen-Chien
authors: WC
authors: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Community-onset bacteremia; De-escalation antimicrobial therapy; Enterobacteriaceae; Septic shock