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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study
Intensive Care Medicine, Volume 46, No. 7, Year 2020
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Description
Purpose: 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. Methods: 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. Results: 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). Conclusion: 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. © 2020, The Author(s).
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC7334278/bin/134_2020_6111_MOESM1_ESM.pdf
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Authors & Co-Authors
de Bus, Liesbet
Belgium, Ghent
Universitair Ziekenhuis Gent
Depuydt, Pieter O.
Belgium, Ghent
Universitair Ziekenhuis Gent
Belgium, Ghent
Universiteit Gent
Tabah, Alexis
Australia, Brisbane
The University of Queensland
Akova, Murat
Turkey, Ankara
Hacettepe Üniversitesi
Cotta, Menino Osbert
Australia, Brisbane
The University of Queensland
De Pascale, Gennaro D.
Italy, Rome
Fondazione Policlinico Universitario Agostino Gemelli Irccs
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Dimopoulos, George T.
Greece, Athens
Attikon University Hospital
Greece, Athens
National and Kapodistrian University of Athens
Garnacho-Montero, José
Spain, Sevilla
Hospital Universitario Virgen Macarena
Spain, Sevilla
Csic-ja-use - Instituto de Biomedicina de Sevilla
Léone, Marc
France, Marseille
Aix Marseille Université
Lipman, Jeffrey
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
France, Montpellier
Université de Montpellier
Ostermann, Marlies Elizabeth
United Kingdom, London
King's College London
Paiva, José Artur
Portugal, Porto
Centro Hospitalar Universitário de São João
Portugal, Porto
Universidade do Porto
Schouten, Jeroen A.
Netherlands, Nijmegen
Radboud University Medical Center
Sjövall, Fredrik
Sweden, Lund
Skånes Universitetssjukhus
Sweden, Lund
Lunds Universitet
Timsit, Jean Franc¸ois
France, Paris
Infection, Anti-microbien, Modélisation, Évolution
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Roberts, Jason A.
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
France, Montpellier
Université de Montpellier
Zahar, Jean Ralph
France, Paris
Infection, Anti-microbien, Modélisation, Évolution
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Zand, Farid
Iran, Shiraz
Shiraz University of Medical Sciences
De Waele, Jan J.
Belgium, Ghent
Universitair Ziekenhuis Gent
Ríos, Fernando Gonçalves
Unknown Affiliation
Attokaran, Antony George
Unknown Affiliation
Fourie, Cheryl
Unknown Affiliation
Eller, Philipp
Unknown Affiliation
Biston, Patrick
Unknown Affiliation
Spapen, Herbert D.M.H.
Unknown Affiliation
Vansteelandt, Stijn K.
Unknown Affiliation
Crespo, Mónica
Unknown Affiliation
Starkopf, Joel
Unknown Affiliation
Cohen, Yves
Unknown Affiliation
Depret, François
Unknown Affiliation
Schaller, Stefan J.
Unknown Affiliation
Arvaniti, Kostoula
Unknown Affiliation
Maghsudi, Behzad
Unknown Affiliation
Masjedi, Mansoor
Unknown Affiliation
Nikandish Noubar, Reza
Unknown Affiliation
Sabetian, Golnar
Unknown Affiliation
Marsh, Brian J.
Unknown Affiliation
Martín-Loeches, Ignacio
Unknown Affiliation
Cortegiani, Andrea
Unknown Affiliation
Deana, Cristian
Unknown Affiliation
Girardis, Massimo
Unknown Affiliation
Pasero, Daniela C.
Unknown Affiliation
Spadaro, S.
Unknown Affiliation
Hashimoto, Satoru
Unknown Affiliation
Kuriyama, Akira
Unknown Affiliation
Hasan, M. Shahnaz
Unknown Affiliation
Sulaiman, Helmi Bin
Unknown Affiliation
Hernández-Cárdenas, Carmen Margarita
Unknown Affiliation
Ñamendys-Silva, Silvio A.
Unknown Affiliation
De Lange, Dylan W.
Unknown Affiliation
Hunfeld, Nicole Geertruida Maria
Unknown Affiliation
Filipescu, Daniela C.
Unknown Affiliation
Grigoras, Ioana
Unknown Affiliation
Tomescu, Dana Rodica
Unknown Affiliation
Alshahrani, Mohammed Saeed Saad
Unknown Affiliation
Estella-García, Ángel
Unknown Affiliation
Alp, Emine
Unknown Affiliation
Korten, Volkan
Unknown Affiliation
Statistics
Citations: 54
Authors: 58
Affiliations: 22
Identifiers
Doi:
10.1007/s00134-020-06111-5
ISSN:
03424642
Research Areas
Health System And Policy
Study Design
Cohort Study