RT Journal Article
T1 Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study.
A1 De-Bus, Liesbet
A1 Depuydt, Pieter
A1 Steen, Johan
A1 Dhaese, Sofie
A1 De-Smet, Ken
A1 Tabah, Alexis
A1 Akova, Murat
A1 Cotta, Menino Osbert
A1 De-Pascale, Gennaro
A1 Dimopoulos, George
A1 Fujitani, Shigeki
A1 Garnacho-Montero, Jose
A1 Leone, Marc
A1 Lipman, Jeffrey
A1 Ostermann, Marlies
A1 Paiva, José-Artur
A1 Schouten, Jeroen
A1 Sjövall, Fredrik
A1 Timsit, Jean-François
A1 Roberts, Jason A
A1 Zahar, Jean-Ralph
A1 Zand, Farid
A1 Zirpe, Kapil
A1 De-Waele, Jan J
K1 Antimicrobial de-escalation
K1 Bacterial infection
K1 Clinical cure
K1 Empirical therapy
K1 Intensive care unit
AB The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
PB Springer
YR 2020
FD 2020-07
LK http://hdl.handle.net/10668/15716
UL http://hdl.handle.net/10668/15716
LA en
NO De Bus L, Depuydt P, Steen J, Dhaese S, De Smet K, Tabah A, et al. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study. Intensive Care Med. 2020 Jul;46(7):1404-1417.
DS RISalud
RD Apr 11, 2025