Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit

Takahiro Niimura1, Yoshito Zamami2, Toru Imai3, Kanako Nagao4, Masafumi Kayano5, Hidenori Sagara6, Mitsuhiro Goda5, Naoto Okada5, Masayuki Chuma7, Kenshi Takechi7, Masaki Imanishi5, Toshihiro Koyama8, Tadashi Koga9, Hironori Nakura4, Toshiaki Sendo10, Keisuke Ishizawa2

1Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
2Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan. Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan.
3Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan.
4Department of Emergency Pharmaceutics, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
5Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan.
6Department of Pharmaceutical Information Sciences, Matsuyama University, Ehime, Japan.
7Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan.
8Department of Clinical Pharmacy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
9Research Support Department, Drug Safety Research Laboratories, Pharmacokinetics and Bioanalysis Center, Shin Nippon Biomedical Laboratories Ltd, Kagoshima, Japan.
10Department of Hospital Pharmacy, Okayama University Hospital, Okayama, Japan.

Abstract


Purpose. Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre. Methods. Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated. Patients were divided into two groups with and without de-escalation, and comparisons were conducted for several variables, including length of hospital stay, and length of antibiotic administration. Two types of subgroup analysis were conducted between patients with septic shock or positive blood cultures. Statistical analysis was conducted using chi-square and Mann-Whitney U tests. Results. The length of hospital stay after diagnosis was significantly shorter for the de-escalation group than for the non-de-escalation group. In the subgroup analysis, de-escalation for blood culture-positive patients was beneficial in terms of the length of hospital stay and length of antibiotic administration. Conclusions. The findings of this study suggest that sepsis treatment de-escalation is beneficial for treatment efficacy and appropriate use of antibiotics.

 

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J Pharm Pharm Sci, 21 (0): 54-59, 2018

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DOI: http://dx.doi.org/10.18433/jpps29737