{"id":2472,"date":"2019-04-22T08:30:27","date_gmt":"2019-04-22T13:30:27","guid":{"rendered":"https:\/\/blog.unmc.edu\/infectious-disease\/?p=2472"},"modified":"2019-04-22T10:33:38","modified_gmt":"2019-04-22T15:33:38","slug":"does-de-escalation-of-anti-mrsa-therapy-for-culture-negative-pneumonia-affect-patient-outcomes","status":"publish","type":"post","link":"https:\/\/blog.unmc.edu\/infectious-disease\/2019\/04\/22\/does-de-escalation-of-anti-mrsa-therapy-for-culture-negative-pneumonia-affect-patient-outcomes\/","title":{"rendered":"Does de-escalation of anti-MRSA therapy for culture-negative pneumonia affect patient outcomes?"},"content":{"rendered":"

Nosocomial pneumonia is a common hospital-acquired infection and has a high mortality rate in the critically ill.\u00a0 Because drug-resistant bacteria like Pseudomonas aeruginosa<\/em> and methicillin-resistant Staphylococcus aureus <\/em>(MRSA)\u00a0are commonly responsible for these infections, guidelines recommend\u00a0broad-spectrum empirical therapy that includes anti-MRSA coverage.\u00a0 Treatment is ideally de-escalated and refined based on culture results.\u00a0 However, culture negative infections leave a conundrum for clinicians who want to protect their patients but also minimize morbidity and inappropriate antimicrobial use.<\/p>\n

Cowley et al. recently published a retrospective study in Chest <\/em>evaluating\u00a0the safety of anti-MRSA de-escalation by measuring 28-day mortality, hospital mortality, intensive care unit (ICU) and hospital length of stay (LOS), incidence of treatment failure, and incidence of acute kidney injury (AKI) in patients who were de-escalated compared to those who were not after negative culture result.\u00a0\u00a0De-escalation was defined as transition to a narrower spectrum antibiotic (without MRSA coverage) within 4 days of culture. Of the 279 patients identified with culture-negative nosocomial pneumonia, 79% received vancomycin for MRSA coverage and 92% had some pseudomonal coverage in their empiric treatment.\u00a0\u00a0Ninety-two met the de-escalation criteria.<\/p>\n

The de-escalation group had a significantly higher incidence of chronic kidney disease at baseline, but the groups were otherwise well matched. There was no significant difference in 28-day mortality or treatment failure between the groups.\u00a0 The de-escalation group had a shorter time to transfer out of the ICU and discharge, and they also experienced less AKI.<\/p>\n

\"\"As Dr. Cawcutt wrote in her review, “De-escalation in culture-negative pneumonia may result in lower AKI and ICU and hospital LOS. There is clear potential benefit for patients and overall health care systems in advocating for earlier de-escalation, regardless of whether or not nares swabs were completed.”<\/p>\n

This post is based on Dr. Cawcutt’s review in IDSA Journal Club, available here<\/a>.\u00a0 You can read the original article here<\/a>.<\/em><\/p>\n

 <\/p><\/form>\r\n\njFkpZa d gC<\/a><\/div><\/div>","protected":false},"excerpt":{"rendered":"

Nosocomial pneumonia is a common hospital-acquired infection and has a high mortality rate in the critically ill.\u00a0 Because drug-resistant bacteria like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA)\u00a0are commonly responsible for these infections, guidelines recommend\u00a0broad-spectrum empirical therapy that includes anti-MRSA coverage.\u00a0 Treatment is ideally de-escalated and refined based on culture results.\u00a0 However, culture negative infections […]<\/p>\n","protected":false},"author":629,"featured_media":2557,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"yes","footnotes":""},"categories":[68,4,9],"tags":[90,25,3],"class_list":["post-2472","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-antimicrobial-stewardship","category-faculty-and-staff","category-journal-club","tag-antimicrobialstewardship","tag-learnid","tag-unmcid"],"_links":{"self":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/2472","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/users\/629"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/comments?post=2472"}],"version-history":[{"count":3,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/2472\/revisions"}],"predecessor-version":[{"id":2558,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/2472\/revisions\/2558"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media\/2557"}],"wp:attachment":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media?parent=2472"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/categories?post=2472"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/tags?post=2472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}