A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the intensive care unit
Tabah, Alexis, Cotta, Menino Osbert, Garnacho-Montero, Jose, Schouten, Jeroen, Roberts, Jason A., Lipman, Jeffrey, Tacey, Mark, Timsit, Jean-François, Leone, Marc, Zahar, Jean Ralph, & De Waele, Jan J. (2016) A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the intensive care unit. Clinical Infectious Diseases, 62(8), pp. 1009-1017.
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.
Impact and interest:
Citation counts are sourced monthly from and citation databases.
These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.
Citations counts from theindexing service can be viewed at the linked Google Scholar™ search.
|Item Type:||Journal Article|
|Keywords:||de-escalation, stewardship, streamlining, resistance|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
|Copyright Owner:||Copyright 2015 The Author|
|Deposited On:||24 May 2016 00:39|
|Last Modified:||25 May 2016 22:45|
Repository Staff Only: item control page