NDLI: De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit

Content Provider	Springer Nature : BioMed Central
Author	Morel, Jérôme Casoetto, Julie Jospé, Richard Aubert, Gérald Terrana, Raphael Dumont, Alain Molliex, Serge Auboyer, Christian
Abstract	Introduction Most data on de-escalation of empirical antimicrobial therapy has focused on ventilator-associated pneumonia. In this retrospective monocentric study, we evaluated de-escalation as part of a global strategy of empiric antibiotherapy management irrespective of the location and the severity of the infection. The goal of this trial was to assess the application of a de-escalation strategy and the impact in terms of re-escalation, recurrent infection and to identify variables associated with de-escalation. Methods All consecutive patients treated with empiric antibiotic therapy and hospitalized in the intensive care unit for at least 72 hours within a period of 16 months were included. We compared the characteristics and outcome of patients who have experienced de-escalation therapy with those who have not. Results A total of 116 patients were studied corresponding to 133 infections. Antibiotic therapy was de-escalated in 60 cases (45%). De-escalation, primarily accomplished by a reduction in the number of antibiotics used, was observed in 52% of severe sepsis or septic shock patients. Adequate empiric antibiotic and use of aminoglycoside were independently linked with de-escalation. De-escalation therapy was associated with a significant reduction of recurrent infection (19% vs 5% P = 0.01). Mortality was not changed by de-escalation. Conclusions As part of a global management of empiric antibiotherapy in an intensive care unit, de-escalation might be safe and feasible in a large proportion of patients.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc9373.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc9373
Journal	Critical Care
Issue Number	6
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2010-12-17
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Intensive Care Unit Severe Sepsis Ventilator Associate Pneumonia Recurrent Infection Broad Spectrum Antibiotic
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit

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