Role of De-escalation of Antibiotic Therapy on Clostridium difficile Infection Risk following Enterobacteriaceae Bacteremia M. Seddon, B. Bookstaver, J. Justo, J. Kohn, H. Rac, S. Dash, M. Al-Hasan South Carolina College of Pharmacy - PGY2 Infectious Disease - Columbia, SC
Background/Purpose: There is paucity of data evaluating the role of early de-escalation of antimicrobial therapy on CDI risk in a cohort of hospitalized patients with bacterial infections. This retrospective cohort study examined the impact of de-escalation off antipseudomonal beta-lactams (APBL) within 48 hours of Enterobacteriaceae bacteremia on CDI risk.
Methodology: Hospitalized adults with Enterobacteriaceae bacteremia at Palmetto Health Hospitals in Columbia, SC from 1 January 2011 through 30 June 2015 were identified. Multivariate Cox proportional hazards regression was used to examine time to CDI in patients who received less than or equal to 48 hours and greater than 48 hours of empirical APBL.
Results: Among 808 patients, 414 received more than 48 hours and 394 received less than or equal to 48 hours of APBL. CDI incidence within 90 days of bacteremia was higher in patients who received greater than 48 hours of APBL than those who received less than or equal to 48 hours of APBL (1.8%, 95% confidence intervals [CI] 0.4%-3.2% vs. 7.0%, 95% CI 4.2%-9.8%). After adjustments for acute severity of illness, chronic comorbidities, length of stay and bacteremia source, receipt of greater than 48 hours of APBL remained independently associated with higher CDI risk (hazard ratio 3.3, 95% CI 1.4_x0013_9.0).
Conclusions: Empirical use of APBL for >48 hours for Enterobacteriaceae bacteremia was an independent risk factor for CDI. Use of risk assessment tools to determine indication for empirical antipseudomonal therapy and rapid diagnostic tests for early de-escalation may reduce CDI incidence in hospitalized patients with Enterobacteriaceae bacteremia.
Presentation Objective: Appraise the role of early de-escalation of antipseudomonal beta-lactam therapy on Clostridium difficile infection risk in hospitalized patients with Enterobacteriaceae bacteremia
Self-Assessment: True/False: De-escalation of APBL within 48 hours in patients with Enterobacteriaceae bacteremia was not associated with CDI risk.
