ReviewIntensive care medicine2019
Rationalizing antimicrobial therapy in the ICU: a narrative review.
Review in Intensive care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
121 citing papers in PubMed, 257 citations in OpenAlex.
- Diagnostic performance and antibiotic impact of droplet digital PCR in suspected sepsis: the PROGRESS trial.Nature communications · 2026Trial
- Review
- Hour-1 Sepsis Bundle: Updated Evidence.Journal of clinical medicine · 2026Review
- Surgical site infection incidence and surgical antibiotic prophylaxis in the ICU patient: a multicenter observational study.Journal of intensive care · 2026Article
- Changes in the microbial spectrum and antimicrobial resistance of bloodstream infections in intensive care units before and during the COVID-19 pandemic.BMC infectious diseases · 2026Article
- Role of diagnostic testing in reducing unnecessary antibiotic use for upper respiratory tract infections in Chinese primary healthcare: a mixed-methods study.BMC primary care · 2026Article
- Article
- Sustaining stewardship: longitudinal evaluation of an integrated antimicrobial programme in the ICU.The Journal of antimicrobial chemotherapy · 2026Article
- Comorbidities and mortality in colistin-resistant gram-negative infections among hospitalized patients in Qassim, Saudi Arabia.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2026Article
- Severe community-acquired pneumonia: an integral approach.Journal of intensive care · 2026Review
- Timing of Antibiotics in ICU Pneumonia: An Observational Association Between Early Treatment and Higher Mortality.Antibiotics (Basel, Switzerland) · 2026Article
- Carbapenem-Resistant Gram-Negative Bacteria: Mechanisms, Pathogen-Specific Strategies.Infection and drug resistance · 2026Review
- Metagenomic next-generation sequencing reveals airway microbial dysbiosis and functional alterations inFrontiers in cellular and infection microbiology · 2026Article
- Duration Matters: Tailoring Antibiotic Therapy for Ventilator-Associated Pneumonia.Antibiotics (Basel, Switzerland) · 2026Review
- Investigation of pathogen resistance in Chinese cancer patients based on bacterial resistance surveillance in 23 provinces, 2016-2023.Frontiers in microbiology · 2026Article
- Performance of metagenomic next-generation sequencing for bloodstream infections in perioperative critically ill patients- aFrontiers in cellular and infection microbiology · 2026Article
- Case Report: Diagnosis and management of severe pneumonia caused by complex mixed infection with multidrug-resistant bacteria and fungi after liver retransplantation.Frontiers in surgery · 2026Article
- Current standard of care for septic shock.Intensive care medicine · 2026Review
- Introduction to XIV updating course of antimicrobials and infectious diseases.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Review
- Therapeutic approach in the critically ill patient with suspected multidrug resistance.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Review
61 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 15 institutions in 10 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.
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Registered trials
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.