title: De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Centre Hospitalier Universitaire, Avenue A Raymond, Saint Etienne, 42055, France. jerome.morel@chu-st-etienne.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Morel
authors.forename: Julie
authors.initials: J
authors.lastname: Casoetto
authors.forename: Richard
authors.initials: R
authors.lastname: Jospé
authors.forename: Gérald
authors.initials: G
authors.lastname: Aubert
authors.forename: Raphael
authors.initials: R
authors.lastname: Terrana
authors.forename: Alain
authors.initials: A
authors.lastname: Dumont
authors.forename: Serge
authors.initials: S
authors.lastname: Molliex
authors.forename: Christian
authors.initials: C
authors.lastname: Auboyer
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003422:Critical Care / Q000379:methods*; D019468:Disease Management; D036262:Empirical Research; D005260:Female; D014943:Global Health; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents