Tabah, AlexisCotta, Menino OsbertGarnacho-Montero, JoseSchouten, JeroenRoberts, Jason ALipman, JeffreyTacey, MarkTimsit, Jean-FrançoisLeone, MarcZahar, Jean RalphDe-Waele, Jan J2023-01-252023-01-252015-12-23Tabah 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.http://hdl.handle.net/10668/9680Antimicrobial 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.ende-escalationresistancestewardshipstreamliningAnti-Bacterial AgentsBacterial InfectionsClinical Trials as TopicCohort StudiesCross InfectionDrug Resistance, MicrobialHumansIntensive Care UnitsSeverity of Illness IndexTreatment Outcomeresearch article26703860Restricted AccessMortalidadRiesgoRiesgoEstudios de cohortesInsuficiencia del tratamientoRevisión sistemáticaIntervalos de confianzaTerapéuticaPacientes10.1093/cid/civ11991537-6591https://academic.oup.com/cid/article-pdf/62/8/1009/16789133/civ1199.pdf