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

Bus L. De; P. Depuydt; J. Steen; S. Dhaese; Smet K. De; A. Tabah; M. Akova; M. O. Cotta; Gennaro De Pascale; G. Dimopoulos; S. Fujitani; J. Garnacho-Montero; M. Leone; J. Lipman; M. Ostermann; Paiva J. -A.; J. Schouten; F. Sjovall; Timsit J. -F.; J. A. Roberts; Zahar J. -R.; F. Zand; K. Zirpe; Waele J. J. De; F. Rios; A. R. Vazquez; M. G. Vidal; G. Zakalik; A. G. Attokaran; I. Banakh; S. Dey-Chatterjee; J. Ewan; J. Ferrier; L. Forbes; C. Fourie; A. Leditschke; L. Murray; P. Eller; P. Biston; S. Bracke; Crop L. De; Schryver N. De; E. Frans; H. Spapen; Malderen C. Van; S. Vansteelandt; D. Vermeiren; E. P. Arevalo; M. Crespo; R. Z. Flores; P. Piza; D. M. Tutillo; A. Elme; A. Kallaste; J. Starkopf; J. Bourenne; M. Calypso; Y. Cohen; C. Dahyot-Fizelier; F. Depret; M. Guillot; N. Imzi; S. Jochmans; A. Kouatchet; A. Lepape; O. Martin; M. Heim; S. J. Schaller; K. Arvaniti; A. Bekridelis; P. Ioannidis; C. Mitrakos; M. N. Papanikolaou; S. Pouriki; A. Vemvetsou; B. Abraham; P. K. Bhattacharya; A. Budugu; S. Dixit; S. Gurav; P. Kandanuri; D. A. Prabhu; D. Rathod; K. Savaru; A. N. Udupa; S. B. Varghese; H. H. Bakhodaei; G. Dabiri; M. J. Fallahi; F. Feiz; M. Firoozifar; V. Khaloo; B. Maghsudi; M. Masjedi; R. Nikandish; G. Sabetian; B. Marsh; I. Martin-Loeches; J. Steiner; M. Barbagallo; Anselmo Caricato; A. Cortegiani; R. D'Andrea; C. Deana; A. Donati; M. Girardis; G. Mandala; G. Panarello; D. Pasero; L. Pelagalli; P. M. Soave; S. Spadaro; Y. Fujita; S. Fujiwara; Y. Hara; H. Hashi; S. Hashimoto; H. Hashimoto; K. Hayakawa; M. Inoue; S. Isokawa; S. Kameda; H. Kamohara; M. Kanamoto; S. Katayama; T. Kawagishi; Y. Kawano; Y. Kida; M. Kita; A. Kobayashi; A. Kuriyama; T. Naito; H. Nashiki; K. Nishiyama; S. Shindo; T. Suzuki; A. Takaba; C. Tanaka; K. Tetsuya; Y. Tomioka; Y. Yanagawa; H. Yoshida; S. Adnan; M. S. Hasan; H. Sulaiman; Lopez G. A. Gasca; C. M. Hernandez-Cardenas; S. A. Namendys-Silva; C. Bethlehem; D. de Lange; N. Hunfeld; S. Numan; H. van Leeuwen; D. Owens; M. Almeida; E. Fragoso; T. Leonor; Pereira J. -M.; D. Filipescu; I. Grigoras; M. Popescu; D. Tomescu; M. S. Alshahrani; M. Alvarez-Gonzalez; I. Barrero-Garcia; M. A. Blasco-Navalpotro; L. Claverias; A. Estella; L. F. Espina; J. L. G. Garmendia; E. G. Prieto; G. Gomez-Prieto; C. J. Conde; F. M. Sagasti; A. M. Cantero; A. Orejas-Gallego; E. Papiol; D. Perez-Civantos; J. C. P. Laderas; J. T. Alvarez; P. Vera-Artazcoz; P. V. Cortes; A. Oldner; M. Spangfors; E. Alp; I. Koksal; V. Korten; A. Ozveren; A. Hall; K. W. Hatton; K. Laudanski

doi:10.1007/s00134-020-06111-5

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

Bus L. De^*, P. Depuydt, J. Steen, S. Dhaese, Smet K. De, A. Tabah, M. Akova, M. O. Cotta, Gennaro De Pascale, G. Dimopoulos, S. Fujitani, J. Garnacho-Montero, M. Leone, J. Lipman, M. Ostermann, Paiva J. -A., J. Schouten, F. Sjovall, Timsit J. -F., J. A. RobertsZahar J. -R., F. Zand, K. Zirpe, Waele J. J. De, F. Rios, A. R. Vazquez, M. G. Vidal, G. Zakalik, A. G. Attokaran, I. Banakh, S. Dey-Chatterjee, J. Ewan, J. Ferrier, L. Forbes, C. Fourie, A. Leditschke, L. Murray, P. Eller, P. Biston, S. Bracke, Crop L. De, Schryver N. De, E. Frans, H. Spapen, Malderen C. Van, S. Vansteelandt, D. Vermeiren, E. P. Arevalo, M. Crespo, R. Z. Flores, P. Piza, D. M. Tutillo, A. Elme, A. Kallaste, J. Starkopf, J. Bourenne, M. Calypso, Y. Cohen, C. Dahyot-Fizelier, F. Depret, M. Guillot, N. Imzi, S. Jochmans, A. Kouatchet, A. Lepape, O. Martin, M. Heim, S. J. Schaller, K. Arvaniti, A. Bekridelis, P. Ioannidis, C. Mitrakos, M. N. Papanikolaou, S. Pouriki, A. Vemvetsou, B. Abraham, P. K. Bhattacharya, A. Budugu, S. Dixit, S. Gurav, P. Kandanuri, D. A. Prabhu, D. Rathod, K. Savaru, A. N. Udupa, S. B. Varghese, H. H. Bakhodaei, G. Dabiri, M. J. Fallahi, F. Feiz, M. Firoozifar, V. Khaloo, B. Maghsudi, M. Masjedi, R. Nikandish, G. Sabetian, B. Marsh, I. Martin-Loeches, J. Steiner, M. Barbagallo, Anselmo Caricato, A. Cortegiani, R. D'Andrea, C. Deana, A. Donati, M. Girardis, G. Mandala, G. Panarello, D. Pasero, L. Pelagalli, P. M. Soave, S. Spadaro, Y. Fujita, S. Fujiwara, Y. Hara, H. Hashi, S. Hashimoto, H. Hashimoto, K. Hayakawa, M. Inoue, S. Isokawa, S. Kameda, H. Kamohara, M. Kanamoto, S. Katayama, T. Kawagishi, Y. Kawano, Y. Kida, M. Kita, A. Kobayashi, A. Kuriyama, T. Naito, H. Nashiki, K. Nishiyama, S. Shindo, T. Suzuki, A. Takaba, C. Tanaka, K. Tetsuya, Y. Tomioka, Y. Yanagawa, H. Yoshida, S. Adnan, M. S. Hasan, H. Sulaiman, Lopez G. A. Gasca, C. M. Hernandez-Cardenas, S. A. Namendys-Silva, C. Bethlehem, D. de Lange, N. Hunfeld, S. Numan, H. van Leeuwen, D. Owens, M. Almeida, E. Fragoso, T. Leonor, Pereira J. -M., D. Filipescu, I. Grigoras, M. Popescu, D. Tomescu, M. S. Alshahrani, M. Alvarez-Gonzalez, I. Barrero-Garcia, M. A. Blasco-Navalpotro, L. Claverias, A. Estella, L. F. Espina, J. L. G. Garmendia, E. G. Prieto, G. Gomez-Prieto, C. J. Conde, F. M. Sagasti, A. M. Cantero, A. Orejas-Gallego, E. Papiol, D. Perez-Civantos, J. C. P. Laderas, J. T. Alvarez, P. Vera-Artazcoz, P. V. Cortes, A. Oldner, M. Spangfors, E. Alp, I. Koksal, V. Korten, A. Ozveren, A. Hall, K. W. Hatton, K. Laudanski

^*Autore corrispondente per questo lavoro

Risultato della ricerca: Contributo in rivista › Articolo

8 Citazioni (Scopus)

Abstract

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.

Lingua originale	Inglese
pagine (da-a)	1404-1417
Numero di pagine	14
Rivista	Intensive Care Medicine
Volume	46
Numero di pubblicazione	7
DOI	https://doi.org/10.1007/s00134-020-06111-5
Stato di pubblicazione	Pubblicato - 2020

All Science Journal Classification (ASJC) codes

Terapia Intensiva e Rianimazione

Keywords

Antimicrobial de-escalation
Bacterial infection
Clinical cure
Empirical therapy
Intensive care unit

Accesso al documento

10.1007/s00134-020-06111-5

Altri file e collegamenti

Cita questo

De, B. L., Depuydt, P., Steen, J., Dhaese, S., De, S. K., Tabah, A., Akova, M., Cotta, M. O., De Pascale, G., Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., -A., P. J., Schouten, J., Sjovall, F., -F., T. J., ... Laudanski, K. (2020). Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study. Intensive Care Medicine, 46(7), 1404-1417. https://doi.org/10.1007/s00134-020-06111-5

@article{8d976bd322c14a47b441e6425748c27d,

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

abstract = "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.",

keywords = "Antimicrobial de-escalation, Bacterial infection, Clinical cure, Empirical therapy, Intensive care unit, Antimicrobial de-escalation, Bacterial infection, Clinical cure, Empirical therapy, Intensive care unit",

author = "De, \{Bus L.\} and P. Depuydt and J. Steen and S. Dhaese and De, \{Smet K.\} and A. Tabah and M. Akova and Cotta, \{M. O.\} and \{De Pascale\}, Gennaro and G. Dimopoulos and S. Fujitani and J. Garnacho-Montero and M. Leone and J. Lipman and M. Ostermann and -A., \{Paiva J.\} and J. Schouten and F. Sjovall and -F., \{Timsit J.\} and Roberts, \{J. A.\} and -R., \{Zahar J.\} and F. Zand and K. Zirpe and De, \{Waele J. J.\} and F. Rios and Vazquez, \{A. R.\} and Vidal, \{M. G.\} and G. Zakalik and Attokaran, \{A. G.\} and I. Banakh and S. Dey-Chatterjee and J. Ewan and J. Ferrier and L. Forbes and C. Fourie and A. Leditschke and L. Murray and P. Eller and P. Biston and S. Bracke and De, \{Crop L.\} and De, \{Schryver N.\} and E. Frans and H. Spapen and Van, \{Malderen C.\} and S. Vansteelandt and D. Vermeiren and Arevalo, \{E. P.\} and M. Crespo and Flores, \{R. Z.\} and P. Piza and Tutillo, \{D. M.\} and A. Elme and A. Kallaste and J. Starkopf and J. Bourenne and M. Calypso and Y. Cohen and C. Dahyot-Fizelier and F. Depret and M. Guillot and N. Imzi and S. Jochmans and A. Kouatchet and A. Lepape and O. Martin and M. Heim and Schaller, \{S. J.\} and K. Arvaniti and A. Bekridelis and P. Ioannidis and C. Mitrakos and Papanikolaou, \{M. N.\} and S. Pouriki and A. Vemvetsou and B. Abraham and Bhattacharya, \{P. K.\} and A. Budugu and S. Dixit and S. Gurav and P. Kandanuri and Prabhu, \{D. A.\} and D. Rathod and K. Savaru and Udupa, \{A. N.\} and Varghese, \{S. B.\} and Bakhodaei, \{H. H.\} and G. Dabiri and Fallahi, \{M. J.\} and F. Feiz and M. Firoozifar and V. Khaloo and B. Maghsudi and M. Masjedi and R. Nikandish and G. Sabetian and B. Marsh and I. Martin-Loeches and J. Steiner and M. Barbagallo and Anselmo Caricato and A. Cortegiani and R. D'Andrea and C. Deana and A. Donati and M. Girardis and G. Mandala and G. Panarello and D. Pasero and L. Pelagalli and Soave, \{P. M.\} and S. Spadaro and Y. Fujita and S. Fujiwara and Y. Hara and H. Hashi and S. Hashimoto and H. Hashimoto and K. Hayakawa and M. Inoue and S. Isokawa and S. Kameda and H. Kamohara and M. Kanamoto and S. Katayama and T. Kawagishi and Y. Kawano and Y. Kida and M. Kita and A. Kobayashi and A. Kuriyama and T. Naito and H. Nashiki and K. Nishiyama and S. Shindo and T. Suzuki and A. Takaba and C. Tanaka and K. Tetsuya and Y. Tomioka and Y. Yanagawa and H. Yoshida and S. Adnan and Hasan, \{M. S.\} and H. Sulaiman and Gasca, \{Lopez G. A.\} and Hernandez-Cardenas, \{C. M.\} and Namendys-Silva, \{S. A.\} and C. Bethlehem and \{de Lange\}, D. and N. Hunfeld and S. Numan and \{van Leeuwen\}, H. and D. Owens and M. Almeida and E. Fragoso and T. Leonor and -M., \{Pereira J.\} and D. Filipescu and I. Grigoras and M. Popescu and D. Tomescu and Alshahrani, \{M. S.\} and M. Alvarez-Gonzalez and I. Barrero-Garcia and Blasco-Navalpotro, \{M. A.\} and L. Claverias and A. Estella and Espina, \{L. F.\} and Garmendia, \{J. L. G.\} and Prieto, \{E. G.\} and G. Gomez-Prieto and Conde, \{C. J.\} and Sagasti, \{F. M.\} and Cantero, \{A. M.\} and A. Orejas-Gallego and E. Papiol and D. Perez-Civantos and Laderas, \{J. C. P.\} and Alvarez, \{J. T.\} and P. Vera-Artazcoz and Cortes, \{P. V.\} and A. Oldner and M. Spangfors and E. Alp and I. Koksal and V. Korten and A. Ozveren and A. Hall and Hatton, \{K. W.\} and K. Laudanski",

year = "2020",

doi = "10.1007/s00134-020-06111-5",

language = "English",

volume = "46",

pages = "1404--1417",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "7",

}

De, BL, Depuydt, P, Steen, J, Dhaese, S, De, SK, Tabah, A, Akova, M, Cotta, MO, De Pascale, G, Dimopoulos, G, Fujitani, S, Garnacho-Montero, J, Leone, M, Lipman, J, Ostermann, M, -A., PJ, Schouten, J, Sjovall, F, -F., TJ, Roberts, JA, -R., ZJ, Zand, F, Zirpe, K, De, WJJ, Rios, F, Vazquez, AR, Vidal, MG, Zakalik, G, Attokaran, AG, Banakh, I, Dey-Chatterjee, S, Ewan, J, Ferrier, J, Forbes, L, Fourie, C, Leditschke, A, Murray, L, Eller, P, Biston, P, Bracke, S, De, CL, De, SN, Frans, E, Spapen, H, Van, MC, Vansteelandt, S, Vermeiren, D, Arevalo, EP, Crespo, M, Flores, RZ, Piza, P, Tutillo, DM, Elme, A, Kallaste, A, Starkopf, J, Bourenne, J, Calypso, M, Cohen, Y, Dahyot-Fizelier, C, Depret, F, Guillot, M, Imzi, N, Jochmans, S, Kouatchet, A, Lepape, A, Martin, O, Heim, M, Schaller, SJ, Arvaniti, K, Bekridelis, A, Ioannidis, P, Mitrakos, C, Papanikolaou, MN, Pouriki, S, Vemvetsou, A, Abraham, B, Bhattacharya, PK, Budugu, A, Dixit, S, Gurav, S, Kandanuri, P, Prabhu, DA, Rathod, D, Savaru, K, Udupa, AN, Varghese, SB, Bakhodaei, HH, Dabiri, G, Fallahi, MJ, Feiz, F, Firoozifar, M, Khaloo, V, Maghsudi, B, Masjedi, M, Nikandish, R, Sabetian, G, Marsh, B, Martin-Loeches, I, Steiner, J, Barbagallo, M, Caricato, A, Cortegiani, A, D'Andrea, R, Deana, C, Donati, A, Girardis, M, Mandala, G, Panarello, G, Pasero, D, Pelagalli, L, Soave, PM, Spadaro, S, Fujita, Y, Fujiwara, S, Hara, Y, Hashi, H, Hashimoto, S, Hashimoto, H, Hayakawa, K, Inoue, M, Isokawa, S, Kameda, S, Kamohara, H, Kanamoto, M, Katayama, S, Kawagishi, T, Kawano, Y, Kida, Y, Kita, M, Kobayashi, A, Kuriyama, A, Naito, T, Nashiki, H, Nishiyama, K, Shindo, S, Suzuki, T, Takaba, A, Tanaka, C, Tetsuya, K, Tomioka, Y, Yanagawa, Y, Yoshida, H, Adnan, S, Hasan, MS, Sulaiman, H, Gasca, LGA, Hernandez-Cardenas, CM, Namendys-Silva, SA, Bethlehem, C, de Lange, D, Hunfeld, N, Numan, S, van Leeuwen, H, Owens, D, Almeida, M, Fragoso, E, Leonor, T, -M., PJ, Filipescu, D, Grigoras, I, Popescu, M, Tomescu, D, Alshahrani, MS, Alvarez-Gonzalez, M, Barrero-Garcia, I, Blasco-Navalpotro, MA, Claverias, L, Estella, A, Espina, LF, Garmendia, JLG, Prieto, EG, Gomez-Prieto, G, Conde, CJ, Sagasti, FM, Cantero, AM, Orejas-Gallego, A, Papiol, E, Perez-Civantos, D, Laderas, JCP, Alvarez, JT, Vera-Artazcoz, P, Cortes, PV, Oldner, A, Spangfors, M, Alp, E, Koksal, I, Korten, V, Ozveren, A, Hall, A, Hatton, KW & Laudanski, K 2020, 'Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study', Intensive Care Medicine, vol. 46, n. 7, pagg. 1404-1417. https://doi.org/10.1007/s00134-020-06111-5

TY - JOUR

T1 - Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

AU - De, Bus L.

AU - Depuydt, P.

AU - Steen, J.

AU - Dhaese, S.

AU - De, Smet K.

AU - Tabah, A.

AU - Akova, M.

AU - Cotta, M. O.

AU - De Pascale, Gennaro

AU - Dimopoulos, G.

AU - Fujitani, S.

AU - Garnacho-Montero, J.

AU - Leone, M.

AU - Lipman, J.

AU - Ostermann, M.

AU - -A., Paiva J.

AU - Schouten, J.

AU - Sjovall, F.

AU - -F., Timsit J.

AU - Roberts, J. A.

AU - -R., Zahar J.

AU - Zand, F.

AU - Zirpe, K.

AU - De, Waele J. J.

AU - Rios, F.

AU - Vazquez, A. R.

AU - Vidal, M. G.

AU - Zakalik, G.

AU - Attokaran, A. G.

AU - Banakh, I.

AU - Dey-Chatterjee, S.

AU - Ewan, J.

AU - Ferrier, J.

AU - Forbes, L.

AU - Fourie, C.

AU - Leditschke, A.

AU - Murray, L.

AU - Eller, P.

AU - Biston, P.

AU - Bracke, S.

AU - De, Crop L.

AU - De, Schryver N.

AU - Frans, E.

AU - Spapen, H.

AU - Van, Malderen C.

AU - Vansteelandt, S.

AU - Vermeiren, D.

AU - Arevalo, E. P.

AU - Crespo, M.

AU - Flores, R. Z.

AU - Piza, P.

AU - Tutillo, D. M.

AU - Elme, A.

AU - Kallaste, A.

AU - Starkopf, J.

AU - Bourenne, J.

AU - Calypso, M.

AU - Cohen, Y.

AU - Dahyot-Fizelier, C.

AU - Depret, F.

AU - Guillot, M.

AU - Imzi, N.

AU - Jochmans, S.

AU - Kouatchet, A.

AU - Lepape, A.

AU - Martin, O.

AU - Heim, M.

AU - Schaller, S. J.

AU - Arvaniti, K.

AU - Bekridelis, A.

AU - Ioannidis, P.

AU - Mitrakos, C.

AU - Papanikolaou, M. N.

AU - Pouriki, S.

AU - Vemvetsou, A.

AU - Abraham, B.

AU - Bhattacharya, P. K.

AU - Budugu, A.

AU - Dixit, S.

AU - Gurav, S.

AU - Kandanuri, P.

AU - Prabhu, D. A.

AU - Rathod, D.

AU - Savaru, K.

AU - Udupa, A. N.

AU - Varghese, S. B.

AU - Bakhodaei, H. H.

AU - Dabiri, G.

AU - Fallahi, M. J.

AU - Feiz, F.

AU - Firoozifar, M.

AU - Khaloo, V.

AU - Maghsudi, B.

AU - Masjedi, M.

AU - Nikandish, R.

AU - Sabetian, G.

AU - Marsh, B.

AU - Martin-Loeches, I.

AU - Steiner, J.

AU - Barbagallo, M.

AU - Caricato, Anselmo

AU - Cortegiani, A.

AU - D'Andrea, R.

AU - Deana, C.

AU - Donati, A.

AU - Girardis, M.

AU - Mandala, G.

AU - Panarello, G.

AU - Pasero, D.

AU - Pelagalli, L.

AU - Soave, P. M.

AU - Spadaro, S.

AU - Fujita, Y.

AU - Fujiwara, S.

AU - Hara, Y.

AU - Hashi, H.

AU - Hashimoto, S.

AU - Hashimoto, H.

AU - Hayakawa, K.

AU - Inoue, M.

AU - Isokawa, S.

AU - Kameda, S.

AU - Kamohara, H.

AU - Kanamoto, M.

AU - Katayama, S.

AU - Kawagishi, T.

AU - Kawano, Y.

AU - Kida, Y.

AU - Kita, M.

AU - Kobayashi, A.

AU - Kuriyama, A.

AU - Naito, T.

AU - Nashiki, H.

AU - Nishiyama, K.

AU - Shindo, S.

AU - Suzuki, T.

AU - Takaba, A.

AU - Tanaka, C.

AU - Tetsuya, K.

AU - Tomioka, Y.

AU - Yanagawa, Y.

AU - Yoshida, H.

AU - Adnan, S.

AU - Hasan, M. S.

AU - Sulaiman, H.

AU - Gasca, Lopez G. A.

AU - Hernandez-Cardenas, C. M.

AU - Namendys-Silva, S. A.

AU - Bethlehem, C.

AU - de Lange, D.

AU - Hunfeld, N.

AU - Numan, S.

AU - van Leeuwen, H.

AU - Owens, D.

AU - Almeida, M.

AU - Fragoso, E.

AU - Leonor, T.

AU - -M., Pereira J.

AU - Filipescu, D.

AU - Grigoras, I.

AU - Popescu, M.

AU - Tomescu, D.

AU - Alshahrani, M. S.

AU - Alvarez-Gonzalez, M.

AU - Barrero-Garcia, I.

AU - Blasco-Navalpotro, M. A.

AU - Claverias, L.

AU - Estella, A.

AU - Espina, L. F.

AU - Garmendia, J. L. G.

AU - Prieto, E. G.

AU - Gomez-Prieto, G.

AU - Conde, C. J.

AU - Sagasti, F. M.

AU - Cantero, A. M.

AU - Orejas-Gallego, A.

AU - Papiol, E.

AU - Perez-Civantos, D.

AU - Laderas, J. C. P.

AU - Alvarez, J. T.

AU - Vera-Artazcoz, P.

AU - Cortes, P. V.

AU - Oldner, A.

AU - Spangfors, M.

AU - Alp, E.

AU - Koksal, I.

AU - Korten, V.

AU - Ozveren, A.

AU - Hall, A.

AU - Hatton, K. W.

AU - Laudanski, K.

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - Antimicrobial de-escalation

KW - Bacterial infection

KW - Clinical cure

KW - Empirical therapy

KW - Intensive care unit

KW - Antimicrobial de-escalation

KW - Bacterial infection

KW - Clinical cure

KW - Empirical therapy

KW - Intensive care unit

UR - https://publicatt.unicatt.it/handle/10807/164705

UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85086169918&origin=inward

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85086169918&origin=inward

U2 - 10.1007/s00134-020-06111-5

DO - 10.1007/s00134-020-06111-5

M3 - Article

SN - 0342-4642

VL - 46

SP - 1404

EP - 1417

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 7

ER -

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

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