Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
De Bus, L; Depuydt, P; Steen, J; Dhaese, S; De Smet, K; Tabah, A; Akova, M; Cotta, MO; De Pascale, G; Dimopoulos, G; Fujitani, S; Garnacho-Montero, J; Leone, M; Lipman, J; Ostermann, M; Paiva, JA; Schouten, J; Sjövall, F; Timsit, JF; Roberts, JA; Zahar, JR; Zand, F; Zirpe, K; De Waele, JJ; DIANA study group.
Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study.
Intensive Care Med. 2020; 46(7):1404-1417
Doi: 10.1007/s00134-020-06111-5
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- Study Group Mitglieder der Med Uni Graz:
- Eller Philipp
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- 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 clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
- Find related publications in this database (Keywords)
- Antimicrobial de-escalation
- Intensive care unit
- Bacterial infection
- Empirical therapy
- Clinical cure