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The average causal systemic antifungal therapy de-escalation effect on 28-day death was evaluated by using a double-robust inverse probability of treatment weight estimator which is a causal inference method based on observational data.
Results: Eight hundred and fifty two patients were enrolled and de escalation therapy was performed on two hundred and sixty seven (31,3 %).
Fig. 4 Polluting goods/industries and escalation effect.
Apart from adaptation to microbiologic results, the other reasons for antibiotic changes were recorded: clinical worsening, new site of infection, antibiotic side effect, de-escalation (withdrawing the non-pivotal antibiotic or switching to a narrow-spectrum antibiotic) and discontinuation of aminoglycosides.
Subgroup analyses did not show any effect of early de-escalation on mortality, and there was no effect of early stopping on morality either (RR 0.98 [0.71–1.35]) (Fig. 10).
Garnacho-Montero et al. [46] demonstrated a protective effect of de-escalation in terms of mortality.
Recently, De Bus [48] et al. analyzed the effect of de-escalation in 478 anti-pseudomonal antibiotic prescriptions and could not find lower rates of resistant organisms after exposure to anti-pseudomonal beta-lactam antibiotics.
To elucidate the effect of de-escalation on mortality, survival curves were constructed and Kaplan-Meier testing was used.
The inspector found staff did not "always use effective de-escalation techniques", which sometimes led to an escalation of behaviour.
This suggests that HPV-positive OPSCCs could be treated with de-escalation protocols to minimize therapy-related side effect without compromising on treatment outcome.
De-escalation can be a challenging issue in SICU patients.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com