%0 Journal Article
%A Tabah, Alexis
%A Cotta, Menino Osbert
%A Garnacho-Montero, Jose
%A Schouten, Jeroen
%A Roberts, Jason A
%A Lipman, Jeffrey
%A Tacey, Mark
%A Timsit, Jean-François
%A Leone, Marc
%A Zahar, Jean Ralph
%A De-Waele, Jan J
%T A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit.
%D 2015
%U http://hdl.handle.net/10668/9680
%X 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.
%K de-escalation
%K resistance
%K stewardship
%K streamlining
%~