A comprehensive evaluation of empirical antibiotic therapy, de-escalation practices, and antimicrobial resistance trends in hospitalized patients

BACKGROUND: Antimicrobial resistance (AMR) represents an escalating global health risk, which makes infectious disease treatment more difficult, especially in hospital environments. The primary elements of antimicrobial stewardship programs (ASPs) include two main activities, which are optimizing empirical antibiotic therapy and implementing timely de-escalation. OBJECTIVES: The study assesses three main objectives which include assessing the effectiveness of empirical antibiotic treatment, studying how antibiotic de-escalation occurs, and evaluating AMR patterns in hospitalized patients at a tertiary care center. MATERIALS AND METHODS: Researchers conducted a prospective observational study which lasted 6 months at a tertiary care teaching hospital. The study included hospitalized patients who received empirical antibiotics during their first 24 h after admission to the hospital. The study collected data about demographic information, infection details, antimicrobial treatment, microbiological results, and clinical outcome measurements. National treatment guidelines were used to evaluate the effectiveness of both empirical and de-escalated treatment methods. The researchers used descriptive and inferential statistical methods to analyze antimicrobial susceptibility patterns and multidrug resistance rates. RESULTS: The study included 300 patients who showed higher number of pediatric patients and male patients. The most common infections were respiratory tract infections which occurred in 34.7% of patients, and urinary tract infections, which occurred in 24.3% of patients. The study found that 47.3% of cases showed positive results for cultures, which mainly involved Gram-negative bacteria. The medical staff prescribed empirical monotherapy to 80.3% of patients, with ceftriaxone being the most frequently used medication. Empirical therapy proved to be suitable for 75.7% of clinical situations, whereas medical staff conducted proper antibiotic de-escalation procedures in 71% of situations. The combination of culture testing with susceptibility testing enabled doctors to select more accurate antibiotic treatments, which produced statistically significant results at (P < 0.05). The highest level of resistance occurred to third-generation cephalosporins and beta-lactam/beta-lactamase inhibitor drug combinations. The study found that 11.3% of isolates contained multidrug-resistant organisms, whereas 2.8% contained extensively drug-resistant organisms. CONCLUSION: Appropriate empirical antibiotic therapy together with timely de-escalation procedures leads to positive clinical results. The high resistance rates which affect commonly used antibiotics demonstrate the necessity for medical facilities to implement routine culture testing and follow local antibiogram guidelines while developing their ASPs.