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).

MedStar author(s):
Citation: Intensive Care Medicine. 46(2):245-265, 2020 02.PMID: 31781835Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anti-Infective Agents/ae [Adverse Effects] | *Critical Illness/th [Therapy] | Anti-Infective Agents/tu [Therapeutic Use] | Antimicrobial Stewardship/st [Standards] | Antimicrobial Stewardship/td [Trends] | Critical Care/og [Organization & Administration] | Critical Care/td [Trends] | Europe | Expert Testimony | Humans | Intensive Care Units/og [Organization & Administration] | Intensive Care Units/td [Trends] | Microbiology/og [Organization & Administration] | Microbiology/td [Trends] | Societies, Medical/td [Trends]Year: 2020Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007ISSN:
  • 0342-4642
Name of journal: Intensive care medicineAbstract: 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).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.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.All authors: Bassetti M, De Waele J, Depuydt P, Garnacho-Montero J, Giamarellou H, Kollef MH, Leone M, Paiva JA, Poulakou G, Rello J, Roberts JA, Schouten J, Shorr AF, Tabah A, Timsit JF, Zahar JROriginally published: Intensive Care Medicine. 2019 Nov 28Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-12-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31781835 Available 31781835

Available online from MWHC library: 1997 - present, Available in print through MWHC library:2002-2007

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).

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.

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.

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