Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study
المؤلفون المشاركون
Salahuddin, Nawal
Amer, Lama
Joseph, Mini
El Hazmi, Alya
Hawa, Hassan
Maghrabi, Khalid
المصدر
Critical Care Research and Practice
العدد
المجلد 2016، العدد 2016 (31 ديسمبر/كانون الأول 2016)، ص ص. 1-7، 7ص.
الناشر
Hindawi Publishing Corporation
تاريخ النشر
2016-07-14
دولة النشر
مصر
عدد الصفحات
7
التخصصات الرئيسية
الملخص EN
Introduction.
Deescalation refers to either discontinuation or a step-down of antimicrobials.
Despite strong recommendations in the Surviving Sepsis Guidelines (2012) to deescalate, actual practices can vary.
Our objective was to identify variables that are associated with deescalation failure.
Methods.
In this prospective study of patients with sepsis/septic shock, patients were categorized into 4 groups based on antibiotic administration: no change in antibiotics, deescalation, escalation (where antibiotics were changed to those with a broader spectrum of antimicrobial coverage), or mixed changes (where both escalation to a broader spectrum of coverage and discontinuation of antibiotics were carried out).
Results.
395 patients were studied; mean APACHE II score was 24 ± 7.8 .
Antimicrobial deescalation occurred in 189 (48%) patients; no changes were made in 156 (39%) patients.
On multivariate regression analysis, failure to deescalate was significantly predicted by hematologic malignancy OR 3.3 (95% CI 1.4–7.4) p < 0.004 , fungal sepsis OR 2.7 (95% CI 1.2–5.8) p = 0.011 , multidrug resistance OR 2.9 (95% CI 1.4–6.0) p = 0.003 , baseline serum procalcitonin OR 1.01 (95% CI 1.003–1.016) p = 0.002 , and SAPS II scores OR 1.01 (95% CI 1.004–1.02) p = 0.006 .
Conclusions.
Current deescalation practices reflect physician reluctance when dealing with complicated, sicker patients or with drug-resistance or fungal sepsis.
Integrating an antibiotic stewardship program may increase physician confidence and provide support towards increasing deescalation rates.
نمط استشهاد جمعية علماء النفس الأمريكية (APA)
Salahuddin, Nawal& Amer, Lama& Joseph, Mini& El Hazmi, Alya& Hawa, Hassan& Maghrabi, Khalid. 2016. Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study. Critical Care Research and Practice،Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1099530
نمط استشهاد الجمعية الأمريكية للغات الحديثة (MLA)
Salahuddin, Nawal…[et al.]. Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study. Critical Care Research and Practice No. 2016 (2016), pp.1-7.
https://search.emarefa.net/detail/BIM-1099530
نمط استشهاد الجمعية الطبية الأمريكية (AMA)
Salahuddin, Nawal& Amer, Lama& Joseph, Mini& El Hazmi, Alya& Hawa, Hassan& Maghrabi, Khalid. Determinants of Deescalation Failure in Critically Ill Patients with Sepsis: A Prospective Cohort Study. Critical Care Research and Practice. 2016. Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1099530
نوع البيانات
مقالات
لغة النص
الإنجليزية
الملاحظات
Includes bibliographical references
رقم السجل
BIM-1099530
قاعدة معامل التأثير والاستشهادات المرجعية العربي "ارسيف Arcif"
أضخم قاعدة بيانات عربية للاستشهادات المرجعية للمجلات العلمية المحكمة الصادرة في العالم العربي
تقوم هذه الخدمة بالتحقق من التشابه أو الانتحال في الأبحاث والمقالات العلمية والأطروحات الجامعية والكتب والأبحاث باللغة العربية، وتحديد درجة التشابه أو أصالة الأعمال البحثية وحماية ملكيتها الفكرية. تعرف اكثر