ArticleCritical care (London, England)2017
Enhanced antimicrobial de-escalation for pneumonia in mechanically ventilated patients: a cross-over study.
Article in Critical care (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02685930 (Pneumonia in the Intensive Care Unit), which is not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Pneumonia in the Intensive Care Unit (ICU) Setting
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review.Antimicrobial resistance and infection control · 2019Pooled it
- De-Escalation of Broad-Spectrum and Last-Resort Antibiotics in Critically Ill Adults with Gram-Negative Infections: A Scoping Review and Evidence-Informed Framework for Tertiary-Care ICUs.Antibiotics (Basel, Switzerland) · 2026Review
- Postoperative Antibiotic Escalation After Major Free-Flap Reconstruction Requiring ICU Admission: Associations with Day-1 Procalcitonin, Shock, and Microbiological Positivity.Life (Basel, Switzerland) · 2026Article
- The Analysis of Missed Antibiotic De-Escalation Opportunities in Gram-Negative Bloodstream Infections.Antibiotics (Basel, Switzerland) · 2025Article
- Assessment of De-Escalation of Empirical Antimicrobial Therapy in Medical Wards with Recognized Prevalence of Multi-Drug-Resistant Pathogens: A Multicenter Prospective Cohort Study in Non-ICU Patients with Microbiologically Documented Infection.Antibiotics (Basel, Switzerland) · 2024Article
- Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study).Antibiotics (Basel, Switzerland) · 2024Article
- Development and application of a nomogram model for the prediction of carbapenem-resistantMicrobiology spectrum · 2024Article
- Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures.Pharmacy (Basel, Switzerland) · 2023Article
- Determinants of Mortality for Ventilated Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia.Critical care explorations · 2023Article
- Antimicrobial therapy of community-acquired pneumonia during stewardship efforts and a coronavirus pandemic: an observational study.BMC pulmonary medicine · 2022Observational
- Prospective Nasal Screening for Methicillin-ResistantOpen forum infectious diseases · 2022Article
- Article
- Pathogen-Negative Sepsis-An Opportunity for Antimicrobial Stewardship.Open forum infectious diseases · 2019Article
- Invasive and non-invasive diagnostic approaches for microbiological diagnosis of hospital-acquired pneumonia.Critical care (London, England) · 2019Article
- Does enhanced antibiotic de-escalation really have no benefit in the ICU?Critical care (London, England) · 2017Article
- A Narrative Review of Antimicrobial Stewardship Interventions within In-patient Settings and Resultant Patient Outcomes.Journal of pharmacy & bioallied sciencesReview
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU).
methodsThis was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center. Patients in the EAD group had their antibiotic orders and microbiology results reviewed daily by a dedicated team comprised of a second-year critical care fellow, an ICU attending physician and an ICU pharmacist. Antibiotic de-escalation recommendations were made when appropriate based on microbiologic test results and clinical response to therapy.
resultsThere were 283 patients evaluable, with suspected pneumonia requiring mechanical ventilation: 139 (49.1%) patients in the RAM group and 144 (50.9%) in the EAD group. Early treatment failure based on clinical deterioration occurred in 33 (23.7%) and 40 (27.8%) patients, respectively (P = 0.438). In the remaining patients, antimicrobial de-escalation occurred in 70 (66.0%) and 70 (67.3%), respectively (P = 0.845). There was no difference between groups in total antibiotic days ((median (interquartile range)) 7.0 days (4.0, 9.0) versus 7.0 days (4.0, 8.8) (P = 0.616)); hospital mortality (25.2% versus 35.4% (P = 0.061)); or hospital duration (12.0 days (6.0, 20.0) versus 11.0 days (6.0, 22.0) (P = 0.918).
conclusionsThe addition of an EAD program to a high-intensity daytime staffing model already practicing a high-level of antibiotic stewardship in an academic ICU was not associated with greater antibiotic de-escalation or a reduction in the overall duration of antibiotic therapy.
trial registrationClinicalTrials.gov, NCT02685930 . Registered on 26 January 2016.
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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.