Antibiotic De-escalation Therapy in Neurosurgical Patients with Ventilator-Associated Pneumonia in Intensive Care Unit: A Retrospective Observational Study

Context: Antibiotic de-escalation practice is gaining interest in the intensive care units (ICU). However, there is limited evidence to support this approach in neurosurgical patients with Ventilator-Associated Pneumonia (VAP) in ICU. Aims: This study examined the practice of antibiotic de-escalation in neurosurgical patients with VAP in ICU and its impact on mortality. Settings and Design: Retrospective cross-sectional study conducted in an ICU of a public hospital in Malaysia. Methods and Material: The electronic medical records of the patients diagnosed with VAP in the ICU were retrieved and relevant data was collected for analysis. Statistical analysis used: Mann-Whitney U-test and Chi- Square Test were used to compare the differences of continuous and categorical data while Logistic Regression and Cox Regression were used to estimate the influence of de-escalation on mortality. Results: Of the 125 VAP patients identified, only 53 (42.4%) were neurosurgical patients. The mean age of these patients was 40.5±15.3 years old. The patients mainly had late-onset VAP. The most common organisms identified included Pseudomonas aeruginosa (19.6%) and Acinetobacter Multidrug-Resistant Organisms (17.9%) while the most commonly used empirical antibiotic was Cefepime (32%). The proportion of patients with antibiotic de-escalation (10 out of 53) was statistically lower than patients without antibiotic de-escalation (43 out of 53). There was no statistically significant difference in ICU-mortality between the de-escalation (2 out of 10) and non-deescalation groups (6 out of 43). Similarly, for the 28-day mortality and survival analysis, no significant difference was found between the two groups. Conclusions: Antibiotic de-escalation practice in neurosurgical patients with VAP in ICU was not associated with a deleterious effect on survival.