Antibiotic De-escalation Therapy in Neurosurgical Patients with Ventilator-Associated Pneumonia in Intensive Care Unit: A Retrospective Observational Study

ABSTRACT

Context: Antibiotic de-escalation practice is gaining interest in the intensive care units (ICU). However, there is limited evidence to support this approach in neurosurgical patients with Ventilator-Associated Pneumonia (VAP) in ICU.Aims: This study examined the practice of antibiotic de-escalation in neurosurgical patients with VAP in ICU and its impact on mortality. Settings and Design: Retrospective cross-sectional study conducted in an ICU of a public hospital in Malaysia.Methods and Material: The electronic medical records of the patients diagnosed with VAP in the ICU were retrieved and relevant data was collected for analysis. Statistical analysis used: Mann-Whitney U-test and Chi- Square Test were used to compare the differences of continuous and categorical data while Logistic Regression and Cox Regression were used to estimate the influence of de-escalation on mortality.Results: Of the 125 VAP patients identified, only 53 (42.4%) were neurosurgical patients. The mean age of these patients was 40.5±15.3 years old. The patients mainly had late-onset VAP. The most common organisms identified included Pseudomonas aeruginosa (19.6%) and Acinetobacter Multidrug-Resistant Organisms (17.9%) while the most commonly used empirical antibiotic was Cefepime (32%). The proportion of patients with antibiotic de-escalation (10 out of 53) was statistically lower than patients without antibiotic de-escalation (43 out of 53). There was no statistically significant difference in ICU-mortality between the de-escalation (2 out of 10) and non-deescalation groups (6 out of 43). Similarly, for the 28-day mortality and survival analysis, no significant difference was found between the two groups.Conclusions: Antibiotic de-escalation practice in neurosurgical patients with VAP in ICU was not associated with a deleterious effect on survival.

KEYWORDS

• Antibiotic de-escalation
• Ventilator-associated pneumonia
• Neurosurgical
• Critical care
• Critically-ill patients

Showing references and in-text citations exactly as published.

• DOI10.5530/ijper.51.1.19Copy

Copyright and licence

© 2017 Author(s)

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. CC BY 4.0

RELATED ARTICLES

Matched on section and article type within this issue of IJPER.

• Article · VOLUME 51, ISSUE 1Using Vincent van Gogh’s Illnesses to Revise Medicinal ChemistryYicheng Mei, Baowei Yang · pp. 9-13Original ArticleSame type: Article
• Article · VOLUME 51, ISSUE 1Effect of integrating research skills with basic sciences in an interdisciplinary integrated endocrine module on students’ satisfaction and performanceZeinab Alrefaie, Basem Eldeek, Nasra Ayuob · pp. 14-19Original ArticleSame type: Article
• Article · VOLUME 51, ISSUE 1Diversity of Pharmacy Faculty Members between UK and USWeixiang Zhang, Yitao Wang, Defang Ouyang · pp. 20-24Original ArticleSame type: Article
• Article · VOLUME 51, ISSUE 1Identification of Potential Inhibitors against the Human Influenza A Virus Targeting the CPSF30 and RNA Binding Domains of the NS1 Protein: An E-Pharmacophore approach.Ishwar Chandra, Abhisek Kumar Behera, Sarah Sabu Cherian · pp. 25-33Original ArticleSame type: Article