RT Journal Article
T1 A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit.
A1 Tabah, Alexis
A1 Cotta, Menino Osbert
A1 Garnacho-Montero, Jose
A1 Schouten, Jeroen
A1 Roberts, Jason A
A1 Lipman, Jeffrey
A1 Tacey, Mark
A1 Timsit, Jean-François
A1 Leone, Marc
A1 Zahar, Jean Ralph
A1 De-Waele, Jan J
K1 de-escalation
K1 resistance
K1 stewardship
K1 streamlining
AB 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.
YR 2015
FD 2015-12-23
LK http://hdl.handle.net/10668/9680
UL http://hdl.handle.net/10668/9680
LA en
NO Tabah A, Cotta MO, Garnacho-Montero J, Schouten J, Roberts JA, Lipman J, et al.  A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis. 2016 Apr 15;62(8):1009-1017.
DS RISalud
RD Apr 19, 2025