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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit
Clinical Infectious Diseases, Volume 62, No. 8, Year 2016
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Description
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. © 2015 The Author. All rights reserved.
Authors & Co-Authors
Tabah, Alexis
Australia, Brisbane
Royal Brisbane and Women's Hospital
Cotta, Menino Osbert
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Garnacho-Montero, José
Spain, Sevilla
Csic-ja-use - Instituto de Biomedicina de Sevilla
Schouten, Jeroen A.
Netherlands, Nijmegen
Canisius Wilhelmina Ziekenhuis
Roberts, Jason A.
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Lipman, Jeffrey
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
Queensland University of Technology
Timsit, Jéan-François Franc¸ois
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
France, Paris
Inserm
Léone, Marc
France, Marseille
Ap-hm Assistance Publique - Hôpitaux de Marseille
Zahar, Jean Ralph
France, Angers
Chu Angers
De Waele, Jan J.
Belgium, Ghent
Universitair Ziekenhuis Gent
Statistics
Citations: 159
Authors: 10
Affiliations: 11
Identifiers
Doi:
10.1093/cid/civ1199
ISSN:
10584838
Study Design
Cohort Study
Study Approach
Systematic review