Long term effects of de-escalation antimicrobial strategy in the burn unit

Abstract

BACKGROUND: De-escalation strategy of antimicrobial therapy demonstrates favorable short-term results: it lowers the mortality and reduces the cost of treatment. The long-term results of applying this strategy in the burn unit had not been studied previously. AIM: To compare the long-term results of the de-escalation approach to antimicrobial therapy on the microbial spectrum, resistance of the hospital microflora and consumption of antimicrobials in the burn unit. MATERIALS AND METHODS: The study comprises the data from the burn unit of the Severstal hospital for 2006, 2012 and 2021: statistical data on mortality and the average duration of hospital stay; microbiological data on spectrum and resistance of bacteria to antimicrobials. RESULTS: The use of the de-escalation strategy of antimicrobial therapy in the burn unit of the Healthcare Institution Severstal for 10 years has reduced mortality, length of stay, consumption of antimicrobials. De-escalation strategy has not significantly affect the spectrum of nosocomial microflora but has lowered the resistance of gram-positive microorganisms to antibiotics. There was a decrease in the drug resistance index for the main pathogens of infectious complications as a result of implementing the de-escalation strategy. CONCLUSIONS: The implementation a de-escalation strategy of antimicrobial therapy requires conducting periodic microbiological monitoring for early correction of starting antimicrobial regimens.