Jose Garnacho-Montero1, Ana Escoresca-Ortega, Esperanza Fernández-Delgado. 1. aCritical Care and Emergency Department, Intensive Care Unit, Virgen del Rocío University Hospital bInstituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla cSpanish Network for Research in Infectious Disease (REIPI), Virgen del Rocío University Hospital, Sevilla, Spain.
Abstract
PURPOSE OF REVIEW: An antimicrobial policy consisting of the initial use of wide-spectrum antimicrobials followed by a reassessment of treatment when culture results are available is termed de-escalation therapy. Our aim is to examine the safety and feasibility of antibiotic de-escalation in critically ill patients providing practical tips about how to accomplish this strategy in the critical care setting. RECENT FINDINGS: Numerous studies have assessed the rates of de-escalation therapy (range from 10 to 60%) in patients with severe sepsis or ventilator-associated pneumonia as well as the factors associated with de-escalation. De-escalation generally refers to a reduction in the spectrum of administered antibiotics through the discontinuation of antibiotics or switching to an agent with a narrower spectrum. Diverse studies have identified the adequacy of initial therapy as a factor independently associated with de-escalation. Negative impact on different outcome measures has not been reported in the observational studies. Two randomized clinical trials have evaluated this strategy in patients with ventilator-associated pneumonia or severe sepsis. These trials alert us about the possibility that this strategy may be linked to a higher rate of reinfections but without an impact on mortality. SUMMARY: Antibiotic de-escalation is a well tolerated management strategy in critically ill patients but unfortunately is not widely adopted.
PURPOSE OF REVIEW: An antimicrobial policy consisting of the initial use of wide-spectrum antimicrobials followed by a reassessment of treatment when culture results are available is termed de-escalation therapy. Our aim is to examine the safety and feasibility of antibiotic de-escalation in critically illpatients providing practical tips about how to accomplish this strategy in the critical care setting. RECENT FINDINGS: Numerous studies have assessed the rates of de-escalation therapy (range from 10 to 60%) in patients with severe sepsis or ventilator-associated pneumonia as well as the factors associated with de-escalation. De-escalation generally refers to a reduction in the spectrum of administered antibiotics through the discontinuation of antibiotics or switching to an agent with a narrower spectrum. Diverse studies have identified the adequacy of initial therapy as a factor independently associated with de-escalation. Negative impact on different outcome measures has not been reported in the observational studies. Two randomized clinical trials have evaluated this strategy in patients with ventilator-associated pneumonia or severe sepsis. These trials alert us about the possibility that this strategy may be linked to a higher rate of reinfections but without an impact on mortality. SUMMARY: Antibiotic de-escalation is a well tolerated management strategy in critically illpatients but unfortunately is not widely adopted.
Authors: Liesbet De Bus; Wouter Denys; Julie Catteeuw; Bram Gadeyne; Karel Vermeulen; Jerina Boelens; Geert Claeys; Jan J De Waele; Johan Decruyenaere; Pieter O Depuydt Journal: Intensive Care Med Date: 2016-03-30 Impact factor: 17.440
Authors: Andrew J Lautz; Adam C Dziorny; Adam R Denson; Kathleen A O'Connor; Marianne R Chilutti; Rachael K Ross; Jeffrey S Gerber; Scott L Weiss Journal: J Pediatr Date: 2016-08-29 Impact factor: 4.406
Authors: Kelly C Gamble; Susan E Smith; Christopher M Bland; Andrea Sikora Newsome; Trisha N Branan; William Anthony Hawkins Journal: Hosp Pharm Date: 2021-05-19
Authors: Massimo Sartelli; Fausto Catena; Fikri M Abu-Zidan; Luca Ansaloni; Walter L Biffl; Marja A Boermeester; Marco Ceresoli; Osvaldo Chiara; Federico Coccolini; Jan J De Waele; Salomone Di Saverio; Christian Eckmann; Gustavo P Fraga; Maddalena Giannella; Massimo Girardis; Ewen A Griffiths; Jeffry Kashuk; Andrew W Kirkpatrick; Vladimir Khokha; Yoram Kluger; Francesco M Labricciosa; Ari Leppaniemi; Ronald V Maier; Addison K May; Mark Malangoni; Ignacio Martin-Loeches; John Mazuski; Philippe Montravers; Andrew Peitzman; Bruno M Pereira; Tarcisio Reis; Boris Sakakushev; Gabriele Sganga; Kjetil Soreide; Michael Sugrue; Jan Ulrych; Jean-Louis Vincent; Pierluigi Viale; Ernest E Moore Journal: World J Emerg Surg Date: 2017-05-04 Impact factor: 5.469