De-escalation therapy among bacteraemic patients with community-acquired pneumonia.

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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.





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Carugati, M, F Franzetti, T Wiemken, RR Kelley, P Peyrani, F Blasi, J Ramirez, S Aliberti, et al. (2015). De-escalation therapy among bacteraemic patients with community-acquired pneumonia. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 21(10). pp. 936.e11–936.e18. 10.1016/j.cmi.2015.06.015 Retrieved from

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Manuela Carugati

Associate Professor of Medicine

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