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Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence.

Authors
  • Lakbar, Ines1
  • De Waele, Jan J2
  • Tabah, Alexis3
  • Einav, Sharon4, 5
  • Martin-Loeches, Ignacio6, 7
  • Leone, Marc8, 9
  • 1 MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France. , (France)
  • 2 Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 3 Intensive Care Unit, Redcliffe and Caboolture Hospitals, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. , (Australia)
  • 4 Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. , (Israel)
  • 5 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. , (Israel)
  • 6 Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. , (Ireland)
  • 7 Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain. , (Spain)
  • 8 MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France. [email protected] , (France)
  • 9 Service d'anesthésie et de réanimation, Aix Marseille Université, Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France. [email protected] , (France)
Type
Published Article
Journal
Advances in therapy
Publication Date
Jul 01, 2020
Volume
37
Issue
7
Pages
3083–3096
Identifiers
DOI: 10.1007/s12325-020-01390-2
PMID: 32462606
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Antimicrobial de-escalation (ADE) is a component of antimicrobial stewardship (AMS) aimed to reduce exposure to broad-spectrum antimicrobials. In the intensive care unit, ADE is a strong recommendation that is moderately applied in clinical practice. Following a systematic review of the literature, we assessed the studies identified on the topic which included one randomized controlled trial and 20 observational studies. The literature shows a low level of evidence, although observational studies suggested that this procedure is safe. The effects of ADE on the level of resistance of ecological systems and especially on the microbiota are unclear. The reviewers recommend de-escalating antimicrobial treatment in patients requiring long-term antibiotic therapy and considering de-escalation in short-term treatments.

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