What is the purpose of de-escalation after culture results in suspected bacteremia?

• A. To broaden coverage.
• B. To shorten therapy duration only.
• C. To tailor therapy and minimize broad-spectrum exposure.
• D. To increase costs.

Answer: (C)

The main idea is antimicrobial stewardship through tailoring therapy when culture data are available. After suspected bacteremia, you start broad-spectrum antibiotics to cover a wide range of possible pathogens. Once the culture and susceptibility results come back, you switch to a narrower agent that specifically covers the identified organism. This de-escalation minimizes broad-spectrum exposure, which helps reduce the development of resistance, lowers the risk of adverse effects, and can cut costs, while still effectively treating the infection.

Expanding coverage would defeat the goal of de-escalation. Focusing only on shortening course without narrowing the spectrum misses the protective impact of targeted therapy. Increasing costs is contrary to the purpose of stewardship.