Ying Guo1, Wei Gao1, Hongxia Yang1, Cheng'en Ma1, Shujian Sui2. 1. Department of Intensive Care Unit, The Second Hospital of Shandong University, China. 2. Department of Cardiovascular Medicine, The Second Hospital of Shandong University, China. Electronic address: sj_sui@sina.com.
Abstract
OBJECTIVE: To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. METHODS: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library. The search terms used were "sepsis," "septic shock" and "de-escalation." The relative risk (RR) with 95% confidence intervals (CI) was used to evaluate the impact of de-escalation therapy on clinical outcomes. RESULTS: Nine individual studies (1873 patients) were included. Mortality trended lower in the de-escalation group as compared with the continuation of broad-spectrum antibiotics group. However, the results were not statistically significant (RR = 0.74, 95% CI 0.54-1.03). CONCLUSION: Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
OBJECTIVE: To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. METHODS: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library. The search terms used were "sepsis," "septic shock" and "de-escalation." The relative risk (RR) with 95% confidence intervals (CI) was used to evaluate the impact of de-escalation therapy on clinical outcomes. RESULTS: Nine individual studies (1873 patients) were included. Mortality trended lower in the de-escalation group as compared with the continuation of broad-spectrum antibiotics group. However, the results were not statistically significant (RR = 0.74, 95% CI 0.54-1.03). CONCLUSION: Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
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