ArticleIntensive care medicine2007
De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate.
Article in Intensive care medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence.Advances in therapy · 2020Pooled it
- Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).Intensive care medicine · 2015Guideline
- De-escalation of antimicrobial therapy for bacteraemia due to difficult-to-treat Gram-negative bacilli.Infection · 2013Trial
- Role of respiratory secretion culture in the surgical outcome prediction of bacterial empyema.General thoracic and cardiovascular surgery · 2025Article
- Simplified Spectrum Score (SScientific reports · 2024Article
- Early Discontinuation of Antibiotics in Patients Admitted With Clinically Suspected Serious Infection but Negative Cultures: Retrospective Cohort Study of Practice Patterns and Outcomes at 111 US Hospitals.Open forum infectious diseases · 2023Article
- Clinical, contextual and hospital-level factors associated with escalation and de-escalation of empiric Gram-negative antibiotics among US inpatients.JAC-antimicrobial resistance · 2023Article
- Antimicrobial Stewardship Program: Reducing Antibiotic's Spectrum of Activity Is not the Solution to Limit the Emergence of Multidrug-Resistant Bacteria.Antibiotics (Basel, Switzerland) · 2022Article
- Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients.JAMA network open · 2021Article
- Trimethoprim-sulfamethoxazole as de-escalation in ventilator-associated pneumonia: a cohort study subanalysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2021Article
- Physician Responsiveness to Positive Blood Culture Results at the Minneapolis Veterans Affairs Hospital-Is Anyone Paying Attention?Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2021Article
- Impact of the multidisciplinary antimicrobial stewardship team intervention focusing on carbapenem de-escalation: A single-centre and interrupted time series analysis.International journal of clinical practice · 2021Article
- Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study.Intensive care medicine · 2020Observational
- Article
- Safety of antimicrobial de-escalation for culture-negative severe pneumonia.Journal of critical care · 2019Article
- Procalcitonin-guided antibiotic discontinuation in ventilator-associated pneumonia: a prospective observational study.Infection and drug resistance · 2019Article
- Are tracheal surveillance cultures useful in the intensive care unit?Annals of translational medicine · 2018Review
- Does enhanced antibiotic de-escalation really have no benefit in the ICU?Critical care (London, England) · 2017Article
- A retrospective study of antibiotic de-escalation in patients with ventilator-associated pneumonia in Malaysia.International journal of clinical pharmacy · 2017Observational
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP).
designProspective observational study.
settingMultidisciplinary intensive care unit. PATIENTS AND
participantsVAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage (BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de-escalation therapy by BAL or tracheal aspirate.
interventionsNone. MEASUREMENTS AND
resultsAntibiotic therapy was de-escalated in 58 patients (40.5%), who had decreased mortality at day 15 (5.1% vs. 31.7%) and day 28 (12% vs. 43.5%) and shorter intensive care unit (17.2 +/- 1.2 vs. 22.7 +/- 6.3 days) and hospital (23.7 +/- 2.8 vs. 29.8 +/- 11.1 days) stay (p < 0.05). Of the 81 patients assigned to tracheal aspirate, the 17 (21%) who achieved de-escalation of therapy had reduced 15-day mortality (5.8% vs. 34.3%), reduced 28-day mortality (11.6% vs. 45.3%), and shorter intensive care unit (17.2 +/- 1.6 vs. 22.4 +/- 6.4 days) and hospital (23.1 +/- 4.4 vs. 29.9 +/- 11.1 days) stay (p < 0.05). Of the 62 patients assigned to BAL, the 41 (66.1%) who achieved de-escalation of therapy had decreased 15-day mortality (4.8% vs. 23.8%), decreased 28-day mortality (12.1% vs. 38%), and shorter intensive care unit (17.2 +/- 1.1 vs. 23.2 +/- 6 days) and hospital (23.8 +/- 2.4 vs. 29.8 +/- 11.4 days) stay (p < 0.05).
conclusionsFor patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy.
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