A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the Intensive Care Unit

Tabah, Alexis, Cotta, Menino Osbert, Garnacho-Montero, Jose, Schouten, Jeroen, Roberts, Jason A., Lipman, Jeffrey, Tacey, Mark, Timsit, Jean-Francois, Leone, Marc, Zahar, Jean Ralph and De Waele, Jan J. (2016) A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the Intensive Care Unit. Clinical Infectious Diseases, 62 8: 1009-1017. doi:10.1093/cid/civ1199


Author Tabah, Alexis
Cotta, Menino Osbert
Garnacho-Montero, Jose
Schouten, Jeroen
Roberts, Jason A.
Lipman, Jeffrey
Tacey, Mark
Timsit, Jean-Francois
Leone, Marc
Zahar, Jean Ralph
De Waele, Jan J.
Title A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the Intensive Care Unit
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1537-6591
1058-4838
Publication date 2016-04-15
Year available 2015
Sub-type Article (original research)
DOI 10.1093/cid/civ1199
Open Access Status Not Open Access
Volume 62
Issue 8
Start page 1009
End page 1017
Total pages 9
Place of publication Cary, NC, United States
Publisher Oxford University Press
Collection year 2017
Language eng
Formatted 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 (P =. 04 to <.001). The pooled effect of ADE on mortality is protective (relative risk, 0.68; 95% confidence interval,. 52-.88). Because the determinants of ADE are markers of clinical improvement and/or of lower risk of treatment failure this effect on mortality cannot be retained as evidence. None of the studies were designed to investigate the effect of ADE on antimicrobial resistance.
Keyword De-escalation
Resistance
Stewardship
Streamlining
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Pharmacy Publications
 
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