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Oxford University Press (OUP), Clinical Infectious Diseases, p. civ1199

DOI: 10.1093/cid/civ1199

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A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the intensive care unit

Journal article published in 2015 by Alexis Tabah ORCID, Menino Osbert Cotta, Jose Garnacho-Montero ORCID, Jeroen Schouten, Jason A. Roberts, Jeffrey Lipman, Mark Tacey ORCID, Jean-François Timsit, Marc Leone, Jean Ralph Zahar, Jan J. De Waele
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

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