Observational studyIntensive care medicine2020
Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study.
Observational study in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07167173 (Predictive Model for Multidrug Resistance in Patients Admitted to the Emergency Department With Sepsis), which is not on this map. Cited by 51 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Predictive Model for Multidrug Resistance in Patients Admitted to the Emergency Department With Sepsis
Who cites it
51 citing papers in PubMed, 1 synthesis or guideline pooled it, 112 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
- Empirical Meropenem Versus Piperacillin/Tazobactam for Critically Ill Adults With Sepsis: Feasibility of a Randomised Trial.Acta anaesthesiologica Scandinavica · 2026Trial
- 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
- The PRECISE framework: a structured approach to antibiogram interpretation for antimicrobial optimization at the bedside.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Impact of appropriate antimicrobial therapy on patient outcomes and antimicrobial use: a sub analysis of the DIANA Study Dataset.Intensive care medicine · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Postoperative Antibiotic Escalation After Major Free-Flap Reconstruction Requiring ICU Admission: Associations with Day-1 Procalcitonin, Shock, and Microbiological Positivity.Life (Basel, Switzerland) · 2026Article
- Timing of Antibiotics in ICU Pneumonia: An Observational Association Between Early Treatment and Higher Mortality.Antibiotics (Basel, Switzerland) · 2026Article
- Day-4 antipseudomonal and anti-MRSA de-escalation was not associated with higher mortality in critically ill patients with sepsis.Frontiers in medicine · 2026Article
- Determinants of empiric combination antibiotic therapy for hospital associated bloodstream infections in the intensive care unit.Scientific reports · 2025Article
- Optimal antibiotic use in the intensive care unit.Critical care (London, England) · 2025Review
- Early prediction of bloodstream infections in ICU patients using machine learning methods based on routine laboratory parameters.BMC infectious diseases · 2025Article
- Population Pharmacokinetic Modeling of Piperacillin/Tazobactam in Healthy Adults and Exploration of Optimal Dosing Strategies.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Ceftazidime/Avibactam for the Treatment of Infections in Children: A Case Series of Real-World Use.Paediatric drugs · 2025Review
- Effect of Empirical Antimicrobial Therapy of Piperacillin-tazobactam Versus Carbapenems on Mortality for Patients with Sepsis from Nursing Homes.Internal medicine (Tokyo, Japan) · 2025Article
- Antibiotic De-Escalation in the Intensive Care Unit: Rationale and Potential Strategies.Antibiotics (Basel, Switzerland) · 2025Review
- Higher target attainment for B-lactam antibiotics in patients with Gram-negative bloodstream infections when four times actual minimum inhibitory concentrations and epidemiological cutoff values are applied compared to clinical breakpoints.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Article
- Carbapenem de-escalation as an antimicrobial stewardship strategy: a narrative review.JAC-antimicrobial resistance · 2025Review
- Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji's National Hospital.Antibiotics (Basel, Switzerland) · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
25 authors at 17 institutions in 14 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation.
methodsAdult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure.
resultsOverall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64).
conclusionADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
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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.