Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit

Takahiro Niimura, Yoshito Zamami, Toru Imai, Kanako Nagao, Masafumi Kayano, Hidenori Sagara, Mitsuhiro Goda, Naoto Okada, Masayuki Chuma, Kenshi Takechi, Masaki Imanishi, Toshihiro Koyama, Tadashi Koga, Hironori Nakura, Toshiaki Sendo, Keisuke Ishizawa

Research output: Contribution to journalArticle

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 deescalation, 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.

Original languageEnglish
Pages (from-to)54-59
Number of pages6
JournalJournal of Pharmacy and Pharmaceutical Sciences
Volume21
Issue number1
DOIs
Publication statusPublished - Feb 13 2018

Fingerprint

Emergency Medical Services
Intensive Care Units
Length of Stay
Sepsis
Anti-Bacterial Agents
Ambulances
Critical Care
Septic Shock
Nonparametric Statistics
Emergencies
Therapeutics
Guidelines

ASJC Scopus subject areas

  • Pharmacology
  • Pharmaceutical Science

Cite this

Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit. / Niimura, Takahiro; Zamami, Yoshito; Imai, Toru; Nagao, Kanako; Kayano, Masafumi; Sagara, Hidenori; Goda, Mitsuhiro; Okada, Naoto; Chuma, Masayuki; Takechi, Kenshi; Imanishi, Masaki; Koyama, Toshihiro; Koga, Tadashi; Nakura, Hironori; Sendo, Toshiaki; Ishizawa, Keisuke.

In: Journal of Pharmacy and Pharmaceutical Sciences, Vol. 21, No. 1, 13.02.2018, p. 54-59.

Research output: Contribution to journalArticle

Niimura, T, Zamami, Y, Imai, T, Nagao, K, Kayano, M, Sagara, H, Goda, M, Okada, N, Chuma, M, Takechi, K, Imanishi, M, Koyama, T, Koga, T, Nakura, H, Sendo, T & Ishizawa, K 2018, 'Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit', Journal of Pharmacy and Pharmaceutical Sciences, vol. 21, no. 1, pp. 54-59. https://doi.org/10.18433/jpps29737
Niimura, Takahiro ; Zamami, Yoshito ; Imai, Toru ; Nagao, Kanako ; Kayano, Masafumi ; Sagara, Hidenori ; Goda, Mitsuhiro ; Okada, Naoto ; Chuma, Masayuki ; Takechi, Kenshi ; Imanishi, Masaki ; Koyama, Toshihiro ; Koga, Tadashi ; Nakura, Hironori ; Sendo, Toshiaki ; Ishizawa, Keisuke. / Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit. In: Journal of Pharmacy and Pharmaceutical Sciences. 2018 ; Vol. 21, No. 1. pp. 54-59.
@article{d519f7dca2e74274b3353724856aa516,
title = "Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit",
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 deescalation, 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.",
author = "Takahiro Niimura and Yoshito Zamami and Toru Imai and Kanako Nagao and Masafumi Kayano and Hidenori Sagara and Mitsuhiro Goda and Naoto Okada and Masayuki Chuma and Kenshi Takechi and Masaki Imanishi and Toshihiro Koyama and Tadashi Koga and Hironori Nakura and Toshiaki Sendo and Keisuke Ishizawa",
year = "2018",
month = "2",
day = "13",
doi = "10.18433/jpps29737",
language = "English",
volume = "21",
pages = "54--59",
journal = "Journal of Pharmacy and Pharmaceutical Sciences",
issn = "1482-1826",
publisher = "Canadian Society for Pharmaceutical Sciences",
number = "1",

}

TY - JOUR

T1 - Evaluation of the benefits of de-escalation for patients with sepsis in the emergency intensive care unit

AU - Niimura, Takahiro

AU - Zamami, Yoshito

AU - Imai, Toru

AU - Nagao, Kanako

AU - Kayano, Masafumi

AU - Sagara, Hidenori

AU - Goda, Mitsuhiro

AU - Okada, Naoto

AU - Chuma, Masayuki

AU - Takechi, Kenshi

AU - Imanishi, Masaki

AU - Koyama, Toshihiro

AU - Koga, Tadashi

AU - Nakura, Hironori

AU - Sendo, Toshiaki

AU - Ishizawa, Keisuke

PY - 2018/2/13

Y1 - 2018/2/13

N2 - 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 deescalation, 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.

AB - 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 deescalation, 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.

UR - http://www.scopus.com/inward/record.url?scp=85044119660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044119660&partnerID=8YFLogxK

U2 - 10.18433/jpps29737

DO - 10.18433/jpps29737

M3 - Article

VL - 21

SP - 54

EP - 59

JO - Journal of Pharmacy and Pharmaceutical Sciences

JF - Journal of Pharmacy and Pharmaceutical Sciences

SN - 1482-1826

IS - 1

ER -