ReviewIntensive care medicine2020
Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions-a viewpoint of experts.
Review in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers.
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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.
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Who cites it
58 citing papers in PubMed.
- Diagnostic value of metagenomic next-generation sequencing for bacterial and fungal detection and its role in antimicrobial therapy adjustment in critically ill patients with non-resolving pneumonia.Annals of medicine · 2026Article
- 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
- Practice model of unit-based clinical pharmacists' individualized daily antimicrobial use density monitoring report on antimicrobial stewardship in intensive care unit of a tertiary hospital in Guangxi, China: an interrupted time series analysis.Antimicrobial resistance and infection control · 2026Article
- Review
- [Sepsis care in Germany: quality indicators on diagnostics and treatment of sepsis].Die Anaesthesiologie · 2026Article
- Burn Infections and Sepsis: Challenges and Future Prospects of Antibacterial Therapy.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
- Evaluation of the clinical impact of de-escalated versus non-de-escalated antibiotics for the treatment of methicillin-susceptible staphylococcus aureus pneumonia in critically ill patients admitted to intensive care units: a multicenter cohort study.BMC infectious diseases · 2026Article
- Determining the Use and Reasons for Non-De-Escalation of Empiric Carbapenem Therapy in a Private Hospital in South Africa.Antibiotics (Basel, Switzerland) · 2025Article
- Spectrum, dose, and duration of antibiotic exposure and risk of intensive care unit-acquired carbapenem-resistant gram-negative bacteria: a prospective cohort study.Annals of intensive care · 2025Article
- Infrastructure and current practice of blood culture diagnostics in patients with sepsis: teachings and recommendations from the European Sepsis Care Survey.Critical care (London, England) · 2025Review
- Propensity-Matched Comparison of Timely vs Delayed Antibiotic Therapy inOpen forum infectious diseases · 2025Article
- The Changing Landscape of Antibiotic Treatment: Reevaluating Treatment Length in the Age of New Agents.Antibiotics (Basel, Switzerland) · 2025Review
- Investigating Bacterial Bloodstream Infections in Dogs and Cats: A 4-Year Surveillance in an Italian Veterinary University Hospital.Veterinary sciences · 2025Article
- Antimicrobial stewardship principles in the evaluation of empirical carbapenem antibiotics in a private hospital in South Africa.JAC-antimicrobial resistance · 2025Article
- Stewarding beyond the 9-5: Implementation of overnight review of rapid blood culture identification panel results by intensive care unit pharmacists.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Efficacy of quality improvement interventions on antibiotic prescription practices for ventilator-associated pneumonia at a tertiary care centre: a prospective pre-post interventional study.BMJ open quality · 2024Article
- Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda.Open forum infectious diseases · 2024Article
- Culture-negative sepsis may be a different entity from culture-positive sepsis: a prospective nationwide multicenter cohort study.Critical care (London, England) · 2024Article
- 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
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5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more components of combination empirical therapy, and/or the change from a broad-spectrum to a narrower spectrum antimicrobial. It is most commonly recommended in the intensive care unit (ICU) patient who is treated with broad-spectrum antibiotics as a strategy to reduce antimicrobial pressure of empirical broad-spectrum therapy and prevent antimicrobial resistance, yet this has not been convincingly demonstrated in a clinical setting. Even if it appears beneficial, ADE may have some unwanted side effects: it has been associated with prolongation of antimicrobial therapy and could inappropriately be used as a justification for unrestricted broadness of empirical therapy. Also, exposing a patient to multiple, sequential antimicrobials could have unwanted effects on the microbiome. For these reasons, ADE has important shortcomings to be promoted as a quality indicator for appropriate antimicrobial use in the ICU. Despite this, ADE clearly has a role in the management of infections in the ICU. The most appropriate use of ADE is in patients with microbiologically confirmed infections requiring longer antimicrobial therapy. ADE should be used as an integral part of an ICU antimicrobial stewardship approach in which it is guided by optimal specimen quality and relevance. Rapid diagnostics may further assist in avoiding unnecessary initiation of broad-spectrum therapy, which in turn will decrease the need for subsequent ADE.
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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.