title: De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis.
abstract: OBJECTIVE
  To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock.
  
  
  METHODS
  We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library. The search terms used were "sepsis," "septic shock" and "de-escalation." The relative risk (RR) with 95% confidence intervals (CI) was used to evaluate the impact of de-escalation therapy on clinical outcomes.
  
  
  RESULTS
  Nine individual studies (1873 patients) were included. Mortality trended lower in the de-escalation group as compared with the continuation of broad-spectrum antibiotics group. However, the results were not statistically significant (RR = 0.74, 95% CI 0.54-1.03).
  
  
  CONCLUSIONS
  Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
authors.affiliation: Department of Intensive Care Unit, The Second Hospital of Shandong University, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Intensive Care Unit, The Second Hospital of Shandong University, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.affiliation: Department of Intensive Care Unit, The Second Hospital of Shandong University, China.
authors.forename: Hongxia
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Intensive Care Unit, The Second Hospital of Shandong University, China.
authors.forename: Cheng'en
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Cardiovascular Medicine, The Second Hospital of Shandong University, China. Electronic address: sj_sui@sina.com.
authors.forename: Shujian
authors.initials: S
authors.lastname: Sui
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D014943:Global Health; D006801:Humans; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D028761:Withholding Treatment / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; De-escalation; Empirical; Septic shock; Severe sepsis