Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study.

Intensive Care Medicine
Liesbet De BusDIANA study group

Abstract

The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for cl...Continue Reading

References

Jul 11, 2001·Critical Care Medicine·M H Kollef
Aug 21, 2001·Critical Care : the Official Journal of the Critical Care Forum·M H Kollef
Apr 9, 2002·Journal of Chemotherapy·M AntonelliG Deangelis
Mar 18, 2004·Journal of Epidemiology and Community Health·M A Hernán
Jun 23, 2006·Journal of Epidemiology and Community Health·Miguel A Hernán, James M Robins
Jun 6, 2007·Intensive Care Medicine·Elpis GiantsouKonstantinos Manolas
Mar 25, 2008·Journal of Critical Care·Ari R JoffeUNKNOWN Canadian Critical Care Trials Group
May 16, 2008·Biometrical Journal. Biometrische Zeitschrift·Torsten HothornPeter Westfall
Dec 3, 2009·JAMA : the Journal of the American Medical Association·Jean-Louis VincentUNKNOWN EPIC II Group of Investigators
Jan 16, 2010·Journal of Critical Care·Jan J De WaeleDirk Vogelaers
Dec 21, 2010·Critical Care : the Official Journal of the Critical Care Forum·Jérôme MorelChristian Auboyer
Jul 29, 2011·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·A-P MagiorakosD L Monnet
Mar 21, 2012·Critical Care Medicine·Sarah HeenenJean-Louis Vincent
Apr 2, 2013·The Cochrane Database of Systematic Reviews·Brenda N G SilvaReinaldo Salomão
Jul 16, 2013·Critical Care : the Official Journal of the Critical Care Forum·Leslie GonzalezSébastien Gibot
Aug 12, 2014·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Karl Madaras-KellyMatthew Samore
Feb 19, 2015·Current Opinion in Infectious Diseases·Jose Garnacho-MonteroEsperanza Fernández-Delgado
Apr 18, 2015·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·E WeissUNKNOWN 'De-escalation' Study Group
Aug 25, 2015·Intensive Care Medicine·Alla PaskovatySusan K Seo
Oct 27, 2015·JAMA : the Journal of the American Medical Association·Jason S Haukoos, Roger J Lewis
Dec 26, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alexis TabahJan J De Waele
Mar 20, 2016·American Journal of Epidemiology·Miguel A Hernán, James M Robins
Apr 16, 2016·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Tamar F BarlamKavita K Trivedi
Oct 25, 2016·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·M PaulA Raz-Pasteur
Jun 25, 2016·Heart & Lung : the Journal of Critical Care·Ying GuoShujian Sui
Jan 20, 2017·Intensive Care Medicine·Andrew RhodesR Phillip Dellinger

❮ Previous
Next ❯

Citations

Nov 4, 2020·Expert Review of Anti-infective Therapy·Nicholas HemingDjillali Annane
Jan 21, 2021·Current Opinion in Anaesthesiology·Lowell LingJeffrey Lipman
Feb 23, 2021·Current Infectious Disease Reports·Aaron J Heffernan, Kerina J Denny
Dec 15, 2020·Critical Care Medicine·Erika P Plata-Menchaca, Ricard Ferrer
Sep 21, 2021·Seminars in Respiratory and Critical Care Medicine·Etienne de Montmollin, Jean-François Timsit
Sep 21, 2021·Seminars in Respiratory and Critical Care Medicine·Erika P Plata-MenchacaRicard Ferrer
Oct 17, 2021·Critical Care : the Official Journal of the Critical Care Forum·Marin H KollefJose Garnacho-Montero

❮ Previous
Next ❯

Clinical Trials Mentioned

NCT02920463

Software Mentioned

R Foundation for Statistical Computing
Electronic Data Capture
R
ipw
splines
geepack
multcomp

Related Concepts

Related Feeds

Carbapenems (ASM)

Carbapenems are members of the beta lactam class of antibiotics and are used for the treatment of severe or high-risk bacterial infections. Discover the latest research on carbapenems here.

Carbapenems

Carbapenems are members of the beta lactam class of antibiotics and are used for the treatment of severe or high-risk bacterial infections. Discover the latest research on carbapenems here.