Baseline predictors of antibiotics de-escalation from empirical therapies in an intensive care unit: a five-year retrospective study

BACKGROUND: The alarming rate of bacterial resistance has urged for vigorous antibiotic de-escalation cultures worldwide. However, the art of de-escalation remains challenging as most clinicians have the fear or stigma that antibiotic de-escalation is strongly associated with higher mortality. This study aimed to determine the factors strongly correlated with higher mortality rates after antibiotic de-escalation and possibly serve as a benchmark study for developing a validated antibiotic de-escalation tool in the near future.

METHOD: This retrospective study was conducted on patients hospitalized in a medical intensive care unit of a referral tertiary care center and subjected to antibiotics de-escalation over five years. Independent factors associated with mortality post antibiotics de-escalation were assessed. Various data were collected, including patient demographics, admission and discharge dates, a primary source of infection and free of infection status, choices of antibiotic used and de-escalation history, vital signs, data on X-ray changes, relevant laboratory investigations, microbiological culture history, mortality status, history of COVID-19 infection, presence of central line, number of vasopressors used, ventilator settings and respective SOFA scores.

RESULTS: Prevalence of mortality among patients continued on broad-spectrum antibiotics empirically is remarkable. Through this study, it was found that the significant factors associated with mortality post antibiotic de-escalation were hospital-acquired infection (HAI) (Adjusted OR: 12.56; 95% CI: 2.88,54.98; p