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).
Anti-Infective Agents
/ adverse effects
Antimicrobial Stewardship
/ standards
Critical Care
/ organization & administration
Critical Illness
/ therapy
Europe
Expert Testimony
Humans
Intensive Care Units
/ organization & administration
Microbiology
/ organization & administration
Societies, Medical
/ trends
Antimicrobial de-escalation
Antimicrobial resistance
De-escalation
Stewardship
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
12
09
2019
accepted:
12
11
2019
pubmed:
30
11
2019
medline:
8
10
2020
entrez:
30
11
2019
Statut:
ppublish
Résumé
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). 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31781835
doi: 10.1007/s00134-019-05866-w
pii: 10.1007/s00134-019-05866-w
doi:
Substances chimiques
Anti-Infective Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
245-265Références
Drug Resist Updat. 2010 Dec;13(6):180-95
pubmed: 21050800
Intensive Care Med. 2015 Nov;41(11):1931-40
pubmed: 26370688
Lancet Infect Dis. 2018 Apr;18(4):391-400
pubmed: 29456043
Ann Intensive Care. 2018 Apr 19;8(1):49
pubmed: 29675561
Antimicrob Agents Chemother. 2008 Sep;52(9):3022-8
pubmed: 18591269
J Crit Care. 2010 Dec;25(4):641-6
pubmed: 20074905
Antimicrob Agents Chemother. 2013 Mar;57(3):1488-95
pubmed: 23318796
Open Forum Infect Dis. 2018 Sep 15;5(10):ofy233
pubmed: 30568975
BMC Infect Dis. 2014 Feb 21;14:97
pubmed: 24559321
J Clin Microbiol. 2012 Apr;50(4):1199-203
pubmed: 22278842
Rev Bras Ter Intensiva. 2016 Sep;28(3):315-322
pubmed: 27626951
Haematologica. 2013 Dec;98(12):1826-35
pubmed: 24323983
Intensive Care Med. 2016 Jun;42(6):1029-39
pubmed: 27025939
Braz J Infect Dis. 2016 Sep-Oct;20(5):437-43
pubmed: 27473893
Lancet Infect Dis. 2017 Jul;17(7):726-734
pubmed: 28442293
Clin Infect Dis. 2014 Apr;58(8):1072-83
pubmed: 24429437
J Antimicrob Chemother. 2019 Jan 1;74(Supplement_1):i6-i15
pubmed: 30690540
Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863
pubmed: 28345952
Antimicrob Agents Chemother. 2015 Dec 28;60(3):1500-8
pubmed: 26711776
J Infect Public Health. 2016 Jul-Aug;9(4):443-51
pubmed: 26688375
Infect Control Hosp Epidemiol. 2014 Sep;35(9):1103-13
pubmed: 25111918
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
N Engl J Med. 2015 May 21;372(21):1996-2005
pubmed: 25992746
Clin Infect Dis. 2019 Aug 30;69(6):956-962
pubmed: 30535051
Clin Infect Dis. 2019 Aug 16;69(5):769-776
pubmed: 30462182
Med Intensiva. 2018 Jun - Jul;42(5):266-273
pubmed: 28882325
Intensive Care Med. 2007 Sep;33(9):1533-40
pubmed: 17549458
Crit Care. 2013 Jul 12;17(4):R140
pubmed: 23849321
Surg Infect (Larchmt). 2016 Feb;17(1):48-52
pubmed: 26714235
Crit Care Med. 2004 Nov;32(11):2183-90
pubmed: 15640629
Crit Care. 2006;10(3):R78
pubmed: 16704742
Crit Care Med. 2018 Mar;46(3):384-393
pubmed: 29189345
Am J Respir Crit Care Med. 1997 Jul;156(1):196-200
pubmed: 9230747
Crit Care. 2010;14(6):R225
pubmed: 21167047
Clin Infect Dis. 2016 May 15;62(10):e51-77
pubmed: 27080992
Clin Microbiol Infect. 2012 Mar;18(3):268-81
pubmed: 21793988
Antimicrob Agents Chemother. 1993 May;37(5):1073-81
pubmed: 8517694
Crit Care Med. 2018 May;46(5):691-698
pubmed: 29271844
Intensive Care Med. 2016 Dec;42(12):2098-2100
pubmed: 27430221
Chest. 2019 Jan;155(1):53-59
pubmed: 30621854
Crit Care. 2015 Feb 04;19:33
pubmed: 25888060
Intensive Care Med. 2015 Nov;41(11):2022-3
pubmed: 26297120
Intensive Care Med. 2015 Jun;41(6):1077-88
pubmed: 25894623
JAMA. 2003 Nov 19;290(19):2588-98
pubmed: 14625336
Crit Care. 2011;15(2):R79
pubmed: 21366903
Clin Infect Dis. 2016 Feb 15;62(4):e1-50
pubmed: 26679628
Chin Med J (Engl). 2018 May 20;131(10):1151-1157
pubmed: 29722334
Intensive Care Med. 2018 Mar;44(3):300-310
pubmed: 29484469
Crit Care Med. 2010 Aug;38(8):1651-64
pubmed: 20562695
Open Forum Infect Dis. 2015 Dec 14;2(4):ofv163
pubmed: 26677456
BMC Infect Dis. 2013 May 15;13:219
pubmed: 23676114
Crit Care Med. 2007 Feb;35(2):379-85; quizz 386
pubmed: 17205011
Crit Care Res Pract. 2016;2016:6794861
pubmed: 27493799
Crit Care. 2012 Feb 15;16(1):R28
pubmed: 22336530
Clin Infect Dis. 2017 Jan 1;64(1):15-23
pubmed: 27678085
Crit Care Med. 2011 Sep;39(9):2048-58
pubmed: 21572328
Crit Care Med. 2006 Jun;34(6):1589-96
pubmed: 16625125
J Chemother. 2001 Nov;13 Spec No 1(1):218-23
pubmed: 11936369
Clin Nephrol. 2016 Jul;86(7):43-50
pubmed: 27251341
Intensive Care Med. 2005 Nov;31(11):1463-5
pubmed: 16151724
Crit Care Med. 2001 Jul;29(7):1473-5
pubmed: 11445712
Crit Care Med. 2012 May;40(5):1404-9
pubmed: 22430235
Clin Microbiol Rev. 2012 Jul;25(3):450-70
pubmed: 22763634
Int J Antimicrob Agents. 2013 Mar;41(3):255-60
pubmed: 23312606
Clin Infect Dis. 2018 Nov 28;67(12):1803-1814
pubmed: 30052813
Crit Care. 2017 Jul 15;21(1):180
pubmed: 28709439
Mycoses. 2014 Jan;57(1):12-8
pubmed: 23710653
J Crit Care. 2008 Mar;23(1):82-90
pubmed: 18359425
Antimicrob Agents Chemother. 2007 May;51(5):1725-30
pubmed: 17307978
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Clin Microbiol Infect. 2016 Dec;22(12):960-967
pubmed: 27283148
J Oncol Pharm Pract. 2016 Oct;22(5):696-701
pubmed: 26227319
Clin Microbiol Infect. 2015 Jul;21(7):649.e1-10
pubmed: 25882363
Intensive Care Med. 2014 Jan;40(1):32-40
pubmed: 24026297
Int J Antimicrob Agents. 2018 Dec;52(6):762-770
pubmed: 30176355
Intensive Care Med. 2014 Jan;40(1):41-9
pubmed: 24231857
Cochrane Database Syst Rev. 2014 Jan 07;(1):CD003344
pubmed: 24395715
J Trauma. 2009 May;66(5):1343-8
pubmed: 19430237
Trials. 2015 Jan 27;16:24
pubmed: 25623485
Crit Care. 2016 Apr 07;20:83
pubmed: 27052675
Int J Clin Pharm. 2017 Aug;39(4):906-912
pubmed: 28643112
Chest. 2006 May;129(5):1210-8
pubmed: 16685011
Intensive Care Med. 2014 Oct;40(10):1399-408
pubmed: 25091790
Antimicrob Agents Chemother. 2015 Aug;59(8):4689-94
pubmed: 26014946
Clin Microbiol Infect. 2012 Dec;18 Suppl 7:19-37
pubmed: 23137135
Clin Infect Dis. 2016 Apr 15;62(8):1009-1017
pubmed: 26703860
BMJ Open. 2017 Jun 9;7(6):e015439
pubmed: 28601833