Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia.

摘要: BACKGROUND Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) lacking. METHODS We carried out retrospective analysis of prospectively collected data cohort hospitalized adults with CAPP. Pneumococcal aetiology was established patients one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids sputum, and/or urinary antigen test. De-escalation therapy considered when the initial narrowed to penicillin, amoxicillin amoxicillin/clavulanate within first 72 h after admission. The primary outcomes were 30 day mortality length hospital stay (LOS). Adjustment confounders performed multivariate propensity score analyses. RESULTS Of 1410 episodes CAPP, admission 166 cases. After adjustment, not associated higher risk (OR = 0.83, 95% CI = 0.24-2.81), but it found be protective factor prolonged LOS (above median) (OR = 0.46, CI = 0.30-0.70). Similar results classified into high-risk severity index classes (IV-V), those clinical instability bacteraemia. No significant differences documented reactions readmission (<30 days). CONCLUSIONS Antibiotic seems safe effective reducing duration LOS, did adversely affect even bacteraemia severe disease, who clinically unstable.