Journal article
A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit
A Tabah, MO Cotta, J Garnacho-Montero, J Schouten, JA Roberts, J Lipman, M Tacey, JF Timsit, M Leone, JR Zahar, JJ De Waele
Clinical Infectious Diseases | OXFORD UNIV PRESS INC | Published : 2016
DOI: 10.1093/cid/civ1199
Abstract
Antimicrobial de-escalation (ADE) is a strategy to reduce the spectrum of antimicrobials and aims to prevent the emergence of bacterial resistance. We present a systematic review describing the definitions, determinants and outcomes associated with ADE. We included 2 randomized controlled trials and 12 cohort studies. There was considerable variability in the definition of ADE. It was more frequently performed in patients with broad-spectrum and/or appropriate antimicrobial therapy (P =. 05 to. 002), when more agents were used (P =. 002), and in the absence of multidrug-resistant pathogens (P <. 05). Where investigated, lower or improving severity scores were consistently associated with ADE..
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Awarded by National Health and Medical Research Council
Funding Acknowledgements
This work originated from discussions within the infection section of the European Society of Intensive Care Medicine. We wish to acknowledge funding to the Burns Trauma and Critical Care Research Centre from the Australian National Health and Medical Research Council for Centre of Research Excellence (APP1099452).