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Published in: Intensive Care Medicine 5/2020

01-05-2020 | Septicemia | Editorial

Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU

Authors: Jean-Francois Timsit, Jeffrey Lipman, Matteo Bassetti

Published in: Intensive Care Medicine | Issue 5/2020

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Excerpt

Intensive care units (ICUs) are the epicenters of antibiotic resistance, because (a) more than 80% of the patients may receive antibiotic treatment on a given day; (b) the illness severity of the patients and the use of invasive procedures increase the likelihood of successful acquisition of and persistent colonization with new strains; (c) the unstable hemodynamic conditions predispose to establishing suboptimal concentrations of antibiotics at the infection site and (d) the high healthcare workload favors the risk of cross-transmission of resistant strains. …
Literature
1.
go back to reference Denny KJ, De Wale J, Laupland KB, Harris PNA, Lipman J (2020) When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit. Clin Microbiol Infect 26:35–40CrossRef Denny KJ, De Wale J, Laupland KB, Harris PNA, Lipman J (2020) When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit. Clin Microbiol Infect 26:35–40CrossRef
2.
go back to reference Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodriguez-Bano J, Ruppe E, Salluh J, Taccone FS, Weiss E, Barbier F (2019) Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 45:172–189CrossRef Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodriguez-Bano J, Ruppe E, Salluh J, Taccone FS, Weiss E, Barbier F (2019) Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 45:172–189CrossRef
3.
go back to reference Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, Jarlier V, Nathwani D, Goossens H (2018) Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health 6:e619–e629CrossRef Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, Jarlier V, Nathwani D, Goossens H (2018) Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health 6:e619–e629CrossRef
4.
go back to reference Patrier J, Timsit JF (2020) Carbapenem use in critically ill patients. Curr Opin Infect Dis 33:86–91CrossRef Patrier J, Timsit JF (2020) Carbapenem use in critically ill patients. Curr Opin Infect Dis 33:86–91CrossRef
6.
go back to reference Tabah A, Bassetti M, Kollef MH, Zahar JR, Paiva JA, Timsit JF, Roberts JA, Schouten J, Giamarellou H, Rello J, De Waele J, Shorr AF, Leone M, Poulakou G, Depuydt P, Garnacho-Montero J (2019) 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). Intensive Care Med. https://doi.org/10.1007/s00134-019-05866-w CrossRefPubMed Tabah A, Bassetti M, Kollef MH, Zahar JR, Paiva JA, Timsit JF, Roberts JA, Schouten J, Giamarellou H, Rello J, De Waele J, Shorr AF, Leone M, Poulakou G, Depuydt P, Garnacho-Montero J (2019) 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). Intensive Care Med. https://​doi.​org/​10.​1007/​s00134-019-05866-w CrossRefPubMed
7.
go back to reference Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, Lucet JC, Paugam-Burtz C, Brun-Buisson C, Timsit JF (2015) Elaboration of a consensual definition of de-escalation allowing a ranking of beta-lactams. Clin Microbiol Infect 21(649):e641–e650 Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, Lucet JC, Paugam-Burtz C, Brun-Buisson C, Timsit JF (2015) Elaboration of a consensual definition of de-escalation allowing a ranking of beta-lactams. Clin Microbiol Infect 21(649):e641–e650
8.
go back to reference Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanese J, Jaber S, Lepape A, Constantin JM, Papazian L, Bruder N, Allaouchiche B, Bezulier K, Antonini F, Textoris J, Martin C (2014) De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med 40:1399–1408CrossRef Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanese J, Jaber S, Lepape A, Constantin JM, Papazian L, Bruder N, Allaouchiche B, Bezulier K, Antonini F, Textoris J, Martin C (2014) De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med 40:1399–1408CrossRef
9.
go back to reference Timsit JF, Harbarth S, Carlet J (2014) De-escalation as a potential way of reducing antibiotic use and antimicrobial resistance in ICU. Intensive Care Med 40:1580–1582CrossRef Timsit JF, Harbarth S, Carlet J (2014) De-escalation as a potential way of reducing antibiotic use and antimicrobial resistance in ICU. Intensive Care Med 40:1580–1582CrossRef
10.
go back to reference De Bus L, Denys W, Catteeuw J, Gadeyne B, Vermeulen K, Boelens J, Claeys G, De Waele JJ, Decruyenaere J, Depuydt PO (2016) Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study. Intensive Care Med 42:1029–1039CrossRef De Bus L, Denys W, Catteeuw J, Gadeyne B, Vermeulen K, Boelens J, Claeys G, De Waele JJ, Decruyenaere J, Depuydt PO (2016) Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study. Intensive Care Med 42:1029–1039CrossRef
11.
go back to reference Hranjec T, Rosenberger LH, Swenson B, Metzger R, Flohr TR, Politano AD, Riccio LM, Popovsky KA, Sawyer RG (2012) Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis 12:774–780CrossRef Hranjec T, Rosenberger LH, Swenson B, Metzger R, Flohr TR, Politano AD, Riccio LM, Popovsky KA, Sawyer RG (2012) Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis 12:774–780CrossRef
12.
go back to reference Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, Kallel H, Schwebel C, Goldgran-Toledano D, Dumenil AS, Argaud L, Ruckly S, Jamali S, Planquette B, Adrie C, Lucet JC, Azoulay E, Timsit JF, Group OS (2015) Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med 43:1798–1806CrossRef Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, Kallel H, Schwebel C, Goldgran-Toledano D, Dumenil AS, Argaud L, Ruckly S, Jamali S, Planquette B, Adrie C, Lucet JC, Azoulay E, Timsit JF, Group OS (2015) Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med 43:1798–1806CrossRef
13.
go back to reference Tangden T, Ramos Martin V, Felton TW, Nielsen EI, Marchand S, Bruggemann RJ, Bulitta JB, Bassetti M, Theuretzbacher U, Tsuji BT, Wareham DW, Friberg LE, De Waele JJ, Tam VH, Roberts JA (2017) The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections. Intensive Care Med 43:1021–1032CrossRef Tangden T, Ramos Martin V, Felton TW, Nielsen EI, Marchand S, Bruggemann RJ, Bulitta JB, Bassetti M, Theuretzbacher U, Tsuji BT, Wareham DW, Friberg LE, De Waele JJ, Tam VH, Roberts JA (2017) The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections. Intensive Care Med 43:1021–1032CrossRef
14.
go back to reference Lockhart GC, Hanin J, Micek ST, Kollef MH (2019) Pathogen-negative sepsis-an opportunity for antimicrobial stewardship. Open Forum Infect Dis 6:ofz397CrossRef Lockhart GC, Hanin J, Micek ST, Kollef MH (2019) Pathogen-negative sepsis-an opportunity for antimicrobial stewardship. Open Forum Infect Dis 6:ofz397CrossRef
15.
go back to reference Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Bassi GL, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R (2017) International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J 50(3):1700582. https://doi.org/10.1183/13993003.00582-2017 CrossRefPubMed Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Bassi GL, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R (2017) International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J 50(3):1700582. https://​doi.​org/​10.​1183/​13993003.​00582-2017 CrossRefPubMed
16.
go back to reference Schnell D, Montlahuc C, Bruneel F, Resche-Rigon M, Kouatchet A, Zahar JR, Darmon M, Pene F, Lemiale V, Rabbat A, Vincent F, Azoulay E, Mokart D (2019) De-escalation of antimicrobial therapy in critically ill hematology patients: a prospective cohort study. Intensive Care Med 45:743–745CrossRef Schnell D, Montlahuc C, Bruneel F, Resche-Rigon M, Kouatchet A, Zahar JR, Darmon M, Pene F, Lemiale V, Rabbat A, Vincent F, Azoulay E, Mokart D (2019) De-escalation of antimicrobial therapy in critically ill hematology patients: a prospective cohort study. Intensive Care Med 45:743–745CrossRef
Metadata
Title
Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU
Authors
Jean-Francois Timsit
Jeffrey Lipman
Matteo Bassetti
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 5/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-05951-5

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