Etiology and risk factors for late antibiotic de-escalation and their effect on intensive care unit outcome

Background: Timely antibiotic de-escalation is essential in intensive care unit (ICU) to prevent the development of antibiotic resistance. This study was undertaken to identify the causes and observe the effects of late antibiotic de-escalation on mortality, length of stay, duration of mechanical ventilation, antibiotic-associated adverse effects, incidence of new infections, and growth of drug-resistant organisms in ICU. Methods: This retrospective study was conducted in a university hospital. A total of 76 consecutively admitted ICU patients were included after retrieving all information from the hospital database and obviating the need for IEC approval. All the enrolled patients had antibiotics initiated and de-escalated in ICU. Those patients for whom antibiotics were initiated before ICU admission were enrolled if their antibiotic prescription was unchanged on ICU admission. Patients with antibiotic de-escalation outside ICU were excluded. The two groups: N-antibiotic de-escalation