ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2025
Antibiotic de-escalation patterns and outcomes in critically ill patients with suspected pneumonia as informed by bronchoalveolar lavage results.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed.
- 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
- Evaluating the Impact of Filmarray Pneumonia Plus Panel in Therapeutic Decision-Making in Critical Patients with Suspected Respiratory Infection.Antibiotics (Basel, Switzerland) · 2026Article
- Pathogen-specific host responses define distinct pneumonia endotypes in the human lung.bioRxiv : the preprint server for biology · 2026Article
- Development of a Pilot Machine Learning Model to Predict Successful Short-Term Treatment Success in Critically Ill Patients With Community-Acquired Pneumonia.CHEST critical care · 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
- The Analysis of Missed Antibiotic De-Escalation Opportunities in Gram-Negative Bloodstream Infections.Antibiotics (Basel, Switzerland) · 2025Article
- Rapid, season-specific PCR testing versus traditional diagnostics for pneumonia in the emergency department.BMC pulmonary medicine · 2025Article
- Application of Real-Time PCR Syndromic Panel on Lower Respiratory Tract Samples: Potential Use for Antimicrobial De-Escalation.Microorganisms · 2025Article
- Impact of Multiplex PCR on Diagnosis of Bacterial and Fungal Infections and Choice of Appropriate Antimicrobial Therapy.Diagnostics (Basel, Switzerland) · 2025Review
- Viral-associated septic shock in pediatric pneumonia: a retrospective analysis of pathogen-specific risks and comparative clinical features with bacterial sepsis.Frontiers in pediatrics · 2025Article
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12 authors.
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Abstract
purposeAntibiotic stewardship in critically ill pneumonia patients is crucial yet challenging, partly due to the limitations of noninvasive diagnostic tests. This study reports an antibiotic de-escalation pattern informed by bronchoalveolar lavage (BAL) results, incorporating quantitative cultures and multiplex PCR rapid diagnostic tests.
methodsWe analyzed data from SCRIPT, a single-center prospective cohort study of mechanically ventilated patients who underwent a BAL for suspected pneumonia. We used the Narrow Antibiotic Therapy (NAT) score to quantify day-by-day antibiotic prescription patterns for each suspected pneumonia episode etiology (bacterial, viral, mixed bacterial/viral, microbiology-negative, and non-pneumonia control). The primary outcome was a composite of in-hospital mortality, discharge to hospice, or requiring lung transplantation during hospitalization, which we referred to as unfavorable outcomes. The secondary outcomes were duration of ICU stay, duration of intubation, and Clostridium difficile during admission. Outcomes were compared across pneumonia etiologies with the Mann-Whitney U test and Fisher's exact test.
resultsAmong 686 patients (409 men, 276 women) with 927 pneumonia episodes, NAT score analysis showed consistent antibiotic de-escalation in all pneumonia etiologies except resistant bacterial pneumonia. Microbiology-negative pneumonia was treated similarly to susceptible bacterial pneumonia. 44% viral episodes had antibiotic cessation by post-BAL day 5. Unfavorable outcomes were comparable across all pneumonia etiologies. Patients with viral and mixed bacterial/viral pneumonia had longer durations of ICU stay and intubation. Clostridium difficile was detected in 14 (2%) patients.
conclusionsBAL quantitative cultures and multiplex PCR rapid diagnostic tests resulted in prompt antibiotic de-escalation in critically ill pneumonia patients. There was no evidence of increased unfavorable outcomes.
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