Evaluation of the prevalence and impact of antimicrobial de-escalation in the treatment of sepsis in patients admitted to a university hospital
DOI:
https://doi.org/10.33448/rsd-v11i14.36637Keywords:
Intensive Care Unit; Antibacterial Agents; Economics, pharmaceutical.Abstract
The objective of the study was to evaluate the prevalence and impact of antimicrobial de-escalation performed in the treatment of sepsis in patients admitted to the Intensive Care Unit (ICU) of a university hospital. It was a retrospective observational study at a university hospital in Paraná, Brazil, with data collected from medical prescriptions and electronic medical records. The pharmacoeconomic analysis used prices available on the CMED list. The results were compared between the groups: de-escalation, escalation and maintenance. Among the 84 patients included, de-escalation was implemented in 57.2% of them, in 91.7% due to spectrum narrowing. There was no difference in mortality and length of ICU stay between the groups (p > 0.05). The length of hospital stay was longer in the de-escalation group (p=0.028). The mean cost of antimicrobial treatment was US$547.22 per patient. Targeted treatment costs were lower in the de-escalation versus de-escalation group (p=0.001). There was no significant difference in the total cost of antimicrobial therapy between the de-escalation and escalation groups (p=0.204). In 40% of the treatments de-escalated by spectrum narrowing were performed inappropriately. The maintenance group had the lowest final treatment cost. In this study, a high prevalence of antimicrobial de-escalation was demonstrated, with no impact on mortality and length of stay in the ICU. Although no significant difference was found between the groups, the de-escalation group had a lower total cost compared to the de-escalation group.
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