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Published in: Intensive Care Medicine 2/2020

01-02-2020 | Antibiotic | Conference Reports and Expert Panel

Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP)

Authors: Alexis Tabah, Matteo Bassetti, Marin H. Kollef, Jean-Ralph Zahar, José-Artur Paiva, Jean-Francois Timsit, Jason A. Roberts, Jeroen Schouten, Helen Giamarellou, Jordi Rello, Jan De Waele, Andrew F. Shorr, Marc Leone, Garyphallia Poulakou, Pieter Depuydt, Jose Garnacho-Montero

Published in: Intensive Care Medicine | Issue 2/2020

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Abstract

Background

Antimicrobial de-escalation (ADE) is a strategy of antimicrobial stewardship, aiming at preventing the emergence of antimicrobial resistance (AMR) by decreasing the exposure to broad-spectrum antimicrobials. There is no high-quality research on ADE and its effects on AMR. Its definition varies and there is little evidence-based guidance for clinicians to use ADE in the intensive care unit (ICU).

Methods

A task force of 16 international experts was formed in November 2016 to provide with guidelines for clinical practice to develop questions targeted at defining ADE, its effects on the ICU population and to provide clinical guidance. Groups of 2 experts were assigned 1–2 questions each within their field of expertise to provide draft statements and rationale. A Delphi method, with 3 rounds and an agreement threshold of 70% was required to reach consensus.

Results

We present a comprehensive document with 13 statements, reviewing the evidence on the definition of ADE, its effects in the ICU population and providing guidance for clinicians in subsets of clinical scenarios where ADE may be considered.

Conclusion

ADE remains a topic of controversy due to the complexity of clinical scenarios where it may be applied and the absence of evidence to the effects it may have on antimicrobial resistance.
Appendix
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Metadata
Title
Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP)
Authors
Alexis Tabah
Matteo Bassetti
Marin H. Kollef
Jean-Ralph Zahar
José-Artur Paiva
Jean-Francois Timsit
Jason A. Roberts
Jeroen Schouten
Helen Giamarellou
Jordi Rello
Jan De Waele
Andrew F. Shorr
Marc Leone
Garyphallia Poulakou
Pieter Depuydt
Jose Garnacho-Montero
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Keywords
Antibiotic
Care
Published in
Intensive Care Medicine / Issue 2/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05866-w

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