title: De-escalation therapy among bacteraemic patients with community-acquired pneumonia.
abstract: There is no evidence supporting the use of de-escalation therapy (DET) among patients with community-acquired pneumonia (CAP). We assessed the outcomes associated with DET among bacteraemic CAP patients. We performed a secondary analysis of the Community-Acquired Pneumonia Organization database, which contains data on 660 bacteraemic patients hospitalized because of CAP in 35 countries (2001-2013). Exclusion criteria were death within 72 h from admission and an inappropriate empirical antibiotic regimen. DET was defined as changing an appropriate empirical broad-spectrum regimen to a narrower-spectrum regimen according to culture results within 7 days from hospital admission. Two study groups were identified: patients whose antibiotic therapy was de-escalated (the DET group), and patients whose antibiotic therapy was not de-escalated (the N-DET group). The primary study outcome was 30-day mortality. Two hundred and sixty-one bacteraemic CAP patients were included. Gram-positive bacteria were responsible for 88.1% of the cases (Streptococcus pneumoniae, 75.9%). Gram-negative bacteria were responsible for for 7.3% of the cases. DET was performed in 165 patients (63.2%). The N-DET group was characterized by a more severe presentation at admission. After adjustment for confounders, DET was not associated with an increased risk of 30-day mortality. DET seems to be safe among bacteraemic patients with CAP. Randomized clinical trials are warranted to further explore these findings.
authors.affiliation: Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy. Electronic address: carugatimanuela@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Carugati
authors.affiliation: Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Franzetti
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: T
authors.initials: T
authors.lastname: Wiemken
authors.forename: R R
authors.initials: RR
authors.lastname: Kelley
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kelly
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Peyrani
authors.affiliation: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Blasi
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Department of Health Sciences, University of Milano - Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Aliberti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteraemia; broad-spectrum antibiotic treatment; community-acquired pneumonia; de-escalation; sepsis