ArticleIntensive care medicine2014
De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock.
Article in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 170 papers, 6 of them syntheses that pooled it.
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Who cites it
170 citing papers in PubMed, 6 syntheses or guidelines pooled it, 386 citations in OpenAlex.
- The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis.The Korean journal of internal medicine · 2023Pooled it
- Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence.Advances in therapy · 2020Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials.Critical care (London, England) · 2018Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).Intensive care medicine · 2015Guideline
- Time to First Culture Positivity Among Critically Ill Adults With Methicillin-ResistantThe Annals of pharmacotherapy · 2020Trial
- Performance and economic evaluation of the molecular detection of pathogens for patients with severe infections: the EVAMICA open-label, cluster-randomised, interventional crossover trial.Intensive care medicine · 2017Trial
- Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Trial
- De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial.Intensive care medicine · 2014Trial
- Evaluation of ambulance blood cultures in patients with suspected sepsis. A rural prospective cohort study.Infection · 2026Article
- Sepsis in Frail Older Adults: Tailored Antimicrobial Stewardship and Individualized Care Approach.Antibiotics (Basel, Switzerland) · 2026Review
- Blood culture practices and microbiological capacity for sepsis diagnostics in Europe (2021-2022): a cross-sectional analysis of the European Sepsis Care Survey.The Lancet regional health. Europe · 2026Article
- Timing of Antibiotics in ICU Pneumonia: An Observational Association Between Early Treatment and Higher Mortality.Antibiotics (Basel, Switzerland) · 2026Article
- Comparative clinical outcomes of ampicillin/sulbactam versus antipseudomonal broad-spectrum antibiotics for community-onset aspiration pneumonia: a propensity score-matched retrospective cohort study based on guideline-recommended strategies in a secondary care hospital in Japan.Journal of rural medicine : JRM · 2026Article
- Therapeutic approach in the critically ill patient with suspected multidrug resistance.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Review
- Optimal antibiotic use in the intensive care unit.Critical care (London, England) · 2025Review
- Interplay between C-reactive protein responses and antibiotic prescribing in people with suspected infection.BMC infectious diseases · 2025Article
- Article
- Multi-center evaluation of the Selux next-generation phenotyping system for gram-negative direct-from-positive blood culture antimicrobial susceptibility testing.Journal of clinical microbiology · 2025Article
110 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposesWe set out to assess the safety and the impact on in-hospital and 90-day mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock.
methodsWe carried out a prospective observational study enrolling patients admitted to the ICU with severe sepsis or septic shock. De-escalation was defined as discontinuation of an antimicrobial agent or change of antibiotic to one with a narrower spectrum once culture results were available. To control for confounding variables, we performed a conventional regression analysis and a propensity score (PS) adjusted-multivariable analysis.
resultsA total of 712 patients with severe sepsis or septic shock at ICU admission were treated empirically with broad-spectrum antibiotics. Of these, 628 were evaluated (84 died before cultures were available). De-escalation was applied in 219 patients (34.9%). By multivariate analysis, factors independently associated with in-hospital mortality were septic shock, SOFA score the day of culture results, and inadequate empirical antimicrobial therapy, whereas de-escalation therapy was a protective factor [Odds-Ratio (OR) 0.58; 95% confidence interval (CI) 0.36-0.93). Analysis of the 403 patients with adequate empirical therapy revealed that the factor associated with mortality was SOFA score on the day of culture results, whereas de-escalation therapy was a protective factor (OR 0.54; 95% CI 0.33-0.89). The PS-adjusted logistic regression models confirmed that de-escalation therapy was a protective factor in both analyses. De-escalation therapy was also a protective factor for 90-day mortality.
conclusionsDe-escalation therapy for severe sepsis and septic shock is a safe strategy associated with a lower mortality. Efforts to increase the frequency of this strategy are fully justified.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.