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

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,...

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Autores principales: Lakbar, Ines, De Waele, Jan J., Tabah, Alexis, Einav, Sharon, Martin-Loeches, Ignacio, Leone, Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2020
Materias:
Review
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252418/
https://www.ncbi.nlm.nih.gov/pubmed/32462606
http://dx.doi.org/10.1007/s12325-020-01390-2
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author Lakbar, Ines
De Waele, Jan J.
Tabah, Alexis
Einav, Sharon
Martin-Loeches, Ignacio
Leone, Marc
author_facet Lakbar, Ines
De Waele, Jan J.
Tabah, Alexis
Einav, Sharon
Martin-Loeches, Ignacio
Leone, Marc
author_sort Lakbar, Ines
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12325-020-01390-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-72524182020-05-28 Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence Lakbar, Ines De Waele, Jan J. Tabah, Alexis Einav, Sharon Martin-Loeches, Ignacio Leone, Marc Adv Ther Review 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12325-020-01390-2) contains supplementary material, which is available to authorized users. Springer Healthcare 2020-05-27 2020 /pmc/articles/PMC7252418/ /pubmed/32462606 http://dx.doi.org/10.1007/s12325-020-01390-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Lakbar, Ines
De Waele, Jan J.
Tabah, Alexis
Einav, Sharon
Martin-Loeches, Ignacio
Leone, Marc
Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title_full Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title_fullStr Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title_full_unstemmed Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title_short Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence
title_sort antimicrobial de-escalation in the icu: from recommendations to level of evidence
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252418/
https://www.ncbi.nlm.nih.gov/pubmed/32462606
http://dx.doi.org/10.1007/s12325-020-01390-2
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