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Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure : the DIANA study

De Bus, Liesbet (author)
Ghent University Hospital
Depuydt, Pieter (author)
Ghent University
Steen, Johan (author)
Ghent University Hospital
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Dhaese, Sofie (author)
De Smet, Ken (author)
Tabah, Alexis (author)
University of Queensland
Akova, Murat (author)
Ankara University
Cotta, Menino Osbert (author)
University of Queensland
De Pascale, Gennaro (author)
Catholic University of the Sacred Heart, Rome
Dimopoulos, George (author)
National and Kapodistrian University of Athens
Fujitani, Shigeki (author)
St. Marianna University Hospital Kawasaki
Garnacho-Montero, Jose (author)
Leone, Marc (author)
Lipman, Jeffrey (author)
Ostermann, Marlies (author)
Paiva, José-Artur (author)
Schouten, Jeroen (author)
Sjövall, Fredrik (author)
Lund University,Lunds universitet,Klinisk neurofysiologi,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Mitokondriell Medicin,Forskargrupper vid Lunds universitet,Clinical Neurophysiology,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Mitochondrial Medicine,Lund University Research Groups,Skåne University Hospital
Timsit, Jean-François (author)
Roberts, Jason A (author)
Zahar, Jean-Ralph (author)
Zand, Farid (author)
Zirpe, Kapil (author)
De Waele, Jan J (author)
Ghent University Hospital
Spångfors, Martin (creator_code:cre_t)
Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SWECRIT,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Central Hospital Kristianstad
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 (creator_code:org_t)
 
2020-06-09
2020
English 14 s.
In: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 46:7, s. 1404-1417
Related links:
http://dx.doi.org/10... (free)
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • PURPOSE: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation.METHODS: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure.RESULTS: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64).CONCLUSION: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

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