NDLI: Collaborative approach of individual participant data of prospective studies of de-escalation in non-immunosuppressed critically ill patients with sepsis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Gutiérrez-Pizarraya, Antonio Leone, Marc Garnacho-Montero, Jose Martin, Claude Martin-Loeches, Ignacio
Description	Country affiliation: Spain Author Affiliation: Gutiérrez-Pizarraya A ( a Department of Intensive Care Medicine , Instituto de Biomedicina de Sevilla, IBIS/Hospitales Universitarios Virgen Macarena -Virgen del Rocío /CSIC/Universidad de Sevilla , Sevilla , Spain.); Leone M ( b Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille , Aix Marseille Université , Marseille , France.); Garnacho-Montero J ( c Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena, Instituto Biomedicina , Sevilla , Spain.); Martin C ( b Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille , Aix Marseille Université , Marseille , France.); Martin-Loeches I ( d Trinity College, St James's University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO) , Dublin , Ireland.)
Abstract	BACKGROUND: There is a concern to conduct de-escalation in very sick patients. AIMS: To determine if de-escalation is feasible in ICU settings. METHODS: We performed a metaanalysis of published studies conducted comparing de-escalation (defined by withdrawal of at least one antimicrobial empirically prescribed, switch to a new antimicrobial with narrower spectrum and withdrawal of at least one antimicrobial plus change of another drug to a new one with narrower spectrum) in non-immunocompromised patients with sepsis admitted to ICU. RESULTS: Eight hundred and seventeen patients with severe sepsis or septic shock were evaluated. De-escalation was applied in 274 patients (33.5%). We found no differences in hospital long of stay between de-escalation group compared to those who did not receive it. We also found significant lower hospital mortality in de-escalation group as compared with no modification group in front of the others (25.9 vs. 43.1%; p < 0.001). Taking into account the etiology of infection, in both gram negative and gram positives microorganisms, de-escalation strategy was assessed as a good prognosis factor for mortality in the adjusted multivariate analysis (OR 0.41; 95% CI 0.22-0.74 and OR 0.33; 95% CI 0.15-0.70 respectively) whereas SOFA score along with age were found as a factors independently associated with a worse clinical outcome (OR 1.23; 95% CI 1.12-1.35 and OR 1.02; 95% CI 1.01-1.04 respectively). CONCLUSIONS: In our study there was an independent association of de-escalation and decrease mortality rate.
File Format	HTM / HTML
ISSN	17512433
Journal	Expert Review of Clinical Pharmacology
e-ISSN	17512441
Language	English
Publisher	Taylor & Francis
Publisher Date	2017-03-02
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology
Content Type	Text
Resource Type	Article
Subject	Pharmacology, Toxicology and Pharmaceutics Pharmacology (medical)

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