International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 906–912 | Cite as

A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia

  • Rahela Ambaras Khan
  • Zoriah AzizEmail author
Research Article


Background Antibiotic de-escalation is an important strategy to conserve the effectiveness of broad-spectrum antibiotics. However, the outcome of this strategy for the treatment of ventilator-associated pneumonia (VAP) has not been widely studied in developing countries. Objectives To evaluate the outcome on intensive care unit (ICU) mortality, 28 days mortality, and length of ICU stay among VAP patients who receive de-escalation therapy. Setting This study was conducted in an ICU of a Malaysian public hospital. Method The electronic medical records of patients who developed VAP in the ICU were retrieved and relevant data was collected. Records of antibiotic prescriptions were also reviewed to collect the details of changes to antibiotic therapy (de-escalation). Main outcome measure Impact of antibiotic de-escalation on mortality. Results The mean age of the 108 patients was 46.2 ± 18.2 years; the majority being males (80%). The antibiotic de-escalation rate was about 30%. Out of this, 84% involved a change from broad to narrow-spectrum antibiotics and the remaining, withdrawal of one or more antibiotics. ICU mortality was 23% while 28 days mortality was 37%. There was no statistically significant difference in mortality rate, survival probability and the mean length of ICU stay between the de-escalation and the non-de-escalation group. However, patients with Simplified Acute Physiology Score II of ≥50 were significantly associated with ICU mortality and 28 days mortality. Conclusions In VAP patients, antibiotic de-escalation provides an opportunity to promote the judicious use of antibiotics without affecting the clinical outcomes.


Antibiotic de-escalation Critically-ill patients Intensive care unit Malaysia Ventilator-associated pneumonia 



The authors wish to thank the Director-General of Health, Malaysia for the permission to publish this paper. We are grateful to Dr. Shanthi Ratnam, Consultant Intensivist of Sungai Buloh Hospital, Dr. Suresh Kumar, Consultant Infectious Disease of Sungai Buloh Hospital and Dr. Kalaiarasu Peariasamy, Senior Consultant and Head of Paediatric Dentistry of Sungai Buloh Hospital and Siti Salwa Mohd Latib for their support towards this research project. We are also thankful to Faculty of Medicine of the University of Malaya and, Clinical Research Centre and Pharmacy Department of Sungai Buloh Hospital for their technical support.



Conflicts of interest

The authors declare no conflict of interest.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pharmacy, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia

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