A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit.
Identifieur interne : 002480 ( Main/Exploration ); précédent : 002479; suivant : 002481A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit.
Auteurs : Alexis Tabah ; Menino Osbert Cotta ; Jose Garnacho-Montero [Espagne] ; Jeroen Schouten [Pays-Bas] ; Jason A. Roberts ; Jeffrey Lipman ; Mark Tacey [Australie] ; Jean-François Timsit ; Marc Leone [France] ; Jean Ralph Zahar [France] ; Jan J. De Waele [Belgique]Source :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1537-6591 ] ; 2016.
Descripteurs français
- KwdFr :
- Antibactériens (effets indésirables), Antibactériens (usage thérapeutique), Essais cliniques comme sujet, Humains, Indice de gravité médicale, Infection croisée (microbiologie), Infection croisée (traitement médicamenteux), Infections bactériennes (), Infections bactériennes (traitement médicamenteux), Résistance microbienne aux médicaments, Résultat thérapeutique, Unités de soins intensifs (), Études de cohortes.
- MESH :
- effets indésirables : Antibactériens.
- microbiologie : Infection croisée.
- traitement médicamenteux : Infection croisée, Infections bactériennes.
- usage thérapeutique : Antibactériens.
- Essais cliniques comme sujet, Humains, Indice de gravité médicale, Infections bactériennes, Résistance microbienne aux médicaments, Résultat thérapeutique, Unités de soins intensifs, Études de cohortes.
English descriptors
- KwdEn :
- Anti-Bacterial Agents (adverse effects), Anti-Bacterial Agents (therapeutic use), Bacterial Infections (drug therapy), Bacterial Infections (prevention & control), Clinical Trials as Topic, Cohort Studies, Cross Infection (drug therapy), Cross Infection (microbiology), Drug Resistance, Microbial, Humans, Intensive Care Units (statistics & numerical data), Severity of Illness Index, Treatment Outcome.
- MESH :
- chemical , adverse effects : Anti-Bacterial Agents.
- chemical , therapeutic use : Anti-Bacterial Agents.
- drug therapy : Bacterial Infections, Cross Infection.
- microbiology : Cross Infection.
- prevention & control : Bacterial Infections.
- statistics & numerical data : Intensive Care Units.
- Clinical Trials as Topic, Cohort Studies, Drug Resistance, Microbial, Humans, Severity of Illness Index, Treatment Outcome.
Abstract
Antimicrobial de-escalation (ADE) is a strategy to reduce the spectrum of antimicrobials and aims to prevent the emergence of bacterial resistance. We present a systematic review describing the definitions, determinants and outcomes associated with ADE. We included 2 randomized controlled trials and 12 cohort studies. There was considerable variability in the definition of ADE. It was more frequently performed in patients with broad-spectrum and/or appropriate antimicrobial therapy (P= .05 to .002), when more agents were used (P= .002), and in the absence of multidrug-resistant pathogens (P< .05). Where investigated, lower or improving severity scores were consistently associated with ADE (P= .04 to <.001). The pooled effect of ADE on mortality is protective (relative risk, 0.68; 95% confidence interval, .52-.88). Because the determinants of ADE are markers of clinical improvement and/or of lower risk of treatment failure this effect on mortality cannot be retained as evidence. None of the studies were designed to investigate the effect of ADE on antimicrobial resistance.
DOI: 10.1093/cid/civ1199
PubMed: 26703860
Affiliations:
- Australie, Belgique, Espagne, France, Pays-Bas
- Gueldre, Provence-Alpes-Côte d'Azur, Victoria (État)
- Marseille, Melbourne, Nimègue
- Université d'Aix-Marseille, Université de Melbourne
Links toward previous steps (curation, corpus...)
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Le document en format XML
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De Waele</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Ghent University Hospital, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Critical Care Medicine, Ghent University Hospital</wicri:regionArea><wicri:noRegion>Ghent University Hospital</wicri:noRegion></affiliation></author></analytic><series><title level="j">Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</title><idno type="eISSN">1537-6591</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anti-Bacterial Agents (adverse effects)</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Bacterial Infections (drug therapy)</term><term>Bacterial Infections (prevention & control)</term><term>Clinical Trials as Topic</term><term>Cohort Studies</term><term>Cross Infection (drug therapy)</term><term>Cross Infection (microbiology)</term><term>Drug Resistance, Microbial</term><term>Humans</term><term>Intensive Care Units (statistics & numerical data)</term><term>Severity of Illness Index</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antibactériens (effets indésirables)</term><term>Antibactériens (usage thérapeutique)</term><term>Essais cliniques comme sujet</term><term>Humains</term><term>Indice de gravité médicale</term><term>Infection croisée (microbiologie)</term><term>Infection croisée (traitement médicamenteux)</term><term>Infections bactériennes ()</term><term>Infections bactériennes (traitement médicamenteux)</term><term>Résistance microbienne aux médicaments</term><term>Résultat thérapeutique</term><term>Unités de soins intensifs ()</term><term>Études de cohortes</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anti-Bacterial Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Bacterial Infections</term><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Antibactériens</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Infection croisée</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Bacterial Infections</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Intensive Care Units</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infection croisée</term><term>Infections bactériennes</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antibactériens</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Clinical Trials as Topic</term><term>Cohort Studies</term><term>Drug Resistance, Microbial</term><term>Humans</term><term>Severity of Illness Index</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Essais cliniques comme sujet</term><term>Humains</term><term>Indice de gravité médicale</term><term>Infections bactériennes</term><term>Résistance microbienne aux médicaments</term><term>Résultat thérapeutique</term><term>Unités de soins intensifs</term><term>Études de cohortes</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Antimicrobial de-escalation (ADE) is a strategy to reduce the spectrum of antimicrobials and aims to prevent the emergence of bacterial resistance. We present a systematic review describing the definitions, determinants and outcomes associated with ADE. We included 2 randomized controlled trials and 12 cohort studies. There was considerable variability in the definition of ADE. It was more frequently performed in patients with broad-spectrum and/or appropriate antimicrobial therapy (P= .05 to .002), when more agents were used (P= .002), and in the absence of multidrug-resistant pathogens (P< .05). Where investigated, lower or improving severity scores were consistently associated with ADE (P= .04 to <.001). The pooled effect of ADE on mortality is protective (relative risk, 0.68; 95% confidence interval, .52-.88). Because the determinants of ADE are markers of clinical improvement and/or of lower risk of treatment failure this effect on mortality cannot be retained as evidence. None of the studies were designed to investigate the effect of ADE on antimicrobial resistance.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Pays-Bas</li></country><region><li>Gueldre</li><li>Provence-Alpes-Côte d'Azur</li><li>Victoria (État)</li></region><settlement><li>Marseille</li><li>Melbourne</li><li>Nimègue</li></settlement><orgName><li>Université d'Aix-Marseille</li><li>Université de Melbourne</li></orgName></list><tree><noCountry><name sortKey="Cotta, Menino Osbert" sort="Cotta, Menino Osbert" uniqKey="Cotta M" first="Menino Osbert" last="Cotta">Menino Osbert Cotta</name><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name><name sortKey="Roberts, Jason A" sort="Roberts, Jason A" uniqKey="Roberts J" first="Jason A" last="Roberts">Jason A. Roberts</name><name sortKey="Tabah, Alexis" sort="Tabah, Alexis" uniqKey="Tabah A" first="Alexis" last="Tabah">Alexis Tabah</name><name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name></noCountry><country name="Espagne"><noRegion><name sortKey="Garnacho Montero, Jose" sort="Garnacho Montero, Jose" uniqKey="Garnacho Montero J" first="Jose" last="Garnacho-Montero">Jose Garnacho-Montero</name></noRegion></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Schouten, Jeroen" sort="Schouten, Jeroen" uniqKey="Schouten J" first="Jeroen" last="Schouten">Jeroen Schouten</name></region></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Tacey, Mark" sort="Tacey, Mark" uniqKey="Tacey M" first="Mark" last="Tacey">Mark Tacey</name></region></country><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name></region><name sortKey="Zahar, Jean Ralph" sort="Zahar, Jean Ralph" uniqKey="Zahar J" first="Jean Ralph" last="Zahar">Jean Ralph Zahar</name></country><country name="Belgique"><noRegion><name sortKey="De Waele, Jan J" sort="De Waele, Jan J" uniqKey="De Waele J" first="Jan J" last="De Waele">Jan J. 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