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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Letter

Does enhanced antibiotic de-escalation really have no benefit in the ICU?

Authors: Shingo Ohki, Shinichiro Ohshimo, Nobuaki Shime

Published in: Critical Care | Issue 1/2017

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Excerpt

In a recent issue of Critical Care, we read with interest the article by Trupka et al. [1], who investigated the utility of an enhanced antimicrobial de-escalation (EAD) program in mechanically ventilated patients with suspected pneumonia. They found that the EAD program did not affect the rate of antibiotic de-escalation or the duration of antibiotic therapy in intensive care units (ICUs). We are very interested in this research because it includes important findings for the indication of antimicrobial stewardship in ICUs. …
Literature
1.
Trupka T, Fisher K, Micek ST, Juang P, Kollef MH. Enhanced antimicrobial de-escalation for pneumonia in mechanically ventilated patients: a cross-over study. Crit Care. 2017;21:180.CrossRefPubMedPubMedCentral
2.
Giantsou E, Liratzopoulos N, Eframidou E, Panopoulou M, Alepopoulou E, Kartali-Ktenidou S, et al. De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate. Intensive Care Med. 2007;33:1533–40.CrossRefPubMed
3.
Raman K, Nailor MD, Nicolau DP, Aslanzadeh J, Nadeau M, Kuti JL. Early antibiotic discontinuation in patients with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoscopy cultures. Crit Care Med. 2013;41:1656–63.CrossRefPubMed
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Carratalà J, Garcia-Vidal C, Ortega L, Fernández-Sabé N, Clemente M, Albero G, et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Arch Inetrn Med. 2012;172:922–8.
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Raman G, Avendano E, Berger S, Menon V. Appropriate initial antibiotic therapy in hospitalized patients with gram-negative infections: systematic review and meta-analysis. BMC Infect Dis. 2015;15:395.CrossRefPubMedPubMedCentral
6.
Ohki S, Ohshimo S, Shime N: Does enhanced antibiotic de-escalation really have no benefit in the ICU? Crit Care. (In press).
7.
Micek ST, Ward S, Fraser VJ, Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004;125(5):1791–9.CrossRefPubMed
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Guillamet CV, Vazquez R, Noe J, Micek ST, Kollef MH. A cohort study of bacteremic pneumonia: The importance of antibiotic resistance and appropriate initial therapy? Medicine. 2016;95(35):e4708.CrossRefPubMedPubMedCentral
Metadata
Title
Does enhanced antibiotic de-escalation really have no benefit in the ICU?
Authors
Shingo Ohki
Shinichiro Ohshimo
Nobuaki Shime
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1845-4

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