Clinical study of empirical de-escalation treatment of sepsis after use of carbapenem antibiotics
HONG Cheng-ying CHEN Huai-sheng LIU Xiao-jun NAN Chuan-chuan LIU Xue-yan▲
Intensive Care Unit, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, 1st Affiliated Hospital of Southern University of Science and Technology
Abstract：Objective To investigate the influencing factors and safety of empirical de-escalation treatment of sepsis after the use carbapenem antibiotics. Methods A total of 29 patients with sepsis who were given empirical de-escalation treatment after the use of carbapenem antibiotics under the guidance of antibiotic management team in the Intensive Care Unit (ICU) of Shenzhen People's Hospital from January 2018 to June 2019 were selected. They were divided into the successful group (18 cases) and the unsuccessful group (11 cases) according to whether the de-escalation treatment succeeded. The etiology situation, inflammatory indicators (procalcitonin [PCT], interleukin-6 [IL-6], neutrophilic granulocyte percentage [N%], and lymphocyte counts), sequential organ failure assessment score (SOFA score), acute physiology and chronic health evaluation Ⅱ (APEACHE Ⅱ) score, length of ICU hospitalization, duration of mechanical ventilation, and duration of shock were compared between the two groups. Results Among 29 included patients, there were 18 patients in the successful group of de-escalation treatment, accounting for 62%. There were significant differences in pathogens and specimen sources between the two groups. At admission, the PCT level of the successful group was higher than that of the unsuccessful group, with statistically significant difference (P＜0.05). At admission, there were no statistically significant differences of SOFA, APACHE Ⅱscores and IL-6 levels between the two groups (P＞0.05).At de-escalation treatment, there were no statistically significant differences of SOFA, APACHE Ⅱscores and IL-6, PCT levels between the two groups (P＞0.05). Before admission, at day 3, 5 of admission, there was no statistically significant difference of N% between the two groups (P＞0.05). Before admission, at day 3, 5 of admission, the lymphocyte counts of the successful group were higher than those of the unsuccessful group in the same-time,with statistically significant differences (P＜0.05). There were no significant differences in length of ICU hospitalization,duration of mechanical ventilation time and duration of shock between the two groups (P＞0.05). Conclusion The differences of pathogens and their sources, and dynamic changes of PCT, IL-6, and peripheral lymphocytes may be important influencing factors for the successful implementation of de-escalation treatment of sepsis after the use of carbapenem antibiotics. The involvement of antibiotic management team may facilitate the implementation of de-escalation treatment. The empirical de-escalation strategy is relatively safe.
洪澄英；陈怀生；刘晓君；南川川；刘雪燕. 使用碳青霉烯类抗生素后经验性降阶梯治疗脓毒症的临床研究[J]. 中国当代医药, 2021, 28(30): 18-22.
HONG Cheng-ying；CHEN Huai-sheng；LIU Xiao-jun；NAN Chuan-chuan；LIU Xue-yan. Clinical study of empirical de-escalation treatment of sepsis after use of carbapenem antibiotics. 中国当代医药, 2021, 28(30): 18-22.
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