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

descriptionPublicationkeyboard_double_arrow_right Article 09 Jun 2020 Belgium, Australia, Belgium, Netherlands, United Kingdom, Italy, Italy, Netherlands, France, Greece, France, Italy, France, Netherlands, Belgium, Italy, Italy English Publisher:Springer Science and Business Media LLCJournal:Intensive Care Medicine, volume 46, pages 1,404-1,417 (issn: 0342-4642, eissn: 1432-1238,

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Authors: De Bus, L.; Depuydt, P.; Steen, J.; Dhaese, S.; De Smet, K.; Tabah, A.; Akova, M.; +185 Authors

De Bus, L.; Depuydt, P.; Steen, J.; Dhaese, S.; De Smet, K.; Tabah, A.; Akova, M.; Cotta, M.O.; De Pascale, G.; Dimopoulos, G.; Fujitani, S.; Garnacho-Montero, J.; Leone, M.; Lipman, J.; Ostermann, M.; Paiva, J.-A.; Schouten, J.; Sjövall, F.; Timsit, J.-F.; Roberts, J.A.; Zahar, J.-R.; Zand, F.; Zirpe, K.; De Waele, J.J.; Rios, F.; Vazquez, A.R.; Vidal, M.G.; Zakalik, G.; Attokaran, A.G.; Banakh, I.; Dey-Chatterjee, S.; Ewan, J.; Ferrier, J.; Forbes, L.; Fourie, C.; Leditschke, A.; Murray, L.; Eller, P.; Biston, P.; Bracke, S.; De Crop, L.; De Schryver, N.; Frans, E.; Spapen, H.; Van Malderen, C.; Vansteelandt, S.; Vermeiren, D.; Arévalo, E.P.; Crespo, M.; Flores, R.Z.; Píza, P.; Tutillo, D.M.; Elme, A.; Kallaste, A.; Starkopf, J.; Bourenne, J.; Calypso, M.; Cohen, Y.; Dahyot-Fizelier, C.; Depret, F.; Guillot, M.; Imzi, N.; Jochmans, S.; Kouatchet, A.; Lepape, A.; Martin, O.; Heim, M.; Schaller, S.J.; Arvaniti, K.; Bekridelis, A.; Ioannidis, P.; Mitrakos, C.; Papanikolaou, M.N.; Pouriki, S.; Vemvetsou, A.; Abraham, B.; Bhattacharya, P.K.; Budugu, A.; Dixit, S.; Gurav, S.; Kandanuri, P.; Prabhu, D.A.; Rathod, D.; Savaru, K.; Udupa, A.N.; Varghese, S.B.; Bakhodaei, H.H.; Dabiri, G.; Fallahi, M.J.; Feiz, F.; Firoozifar, M.; Khaloo, V.; Maghsudi, B.; Masjedi, M.; Nikandish, R.; Sabetian, G.; Marsh, B.; Martin-Loeches, I.; Steiner, J.; Barbagallo, M.; Caricato, A.; Cortegiani, A.; D’Andrea, R.; Deana, C.; Donati, A.; Girardis, M.; Mandalà, G.; Panarello, G.; Pasero, D.; Pelagalli, L.; Soave, P.M.; Spadaro, S.; Fujita, Y.; Fujiwara, S.; Hara, Y.; Hashi, H.; Hashimoto, S.; Hashimoto, H.; Hayakawa, K.; Inoue, M.; Isokawa, S.; Kameda, S.; Kamohara, H.; Kanamoto, M.; Katayama, S.; Kawagishi, T.; Kawano, Y.; Kida, Y.; Kita, M.; Kobayashi, A.; Kuriyama, A.; Naito, T.; Nashiki, H.; Nishiyama, K.; Shindo, S.; Suzuki, T.; Takaba, A.; Tanaka, C.; Tetsuya, K.; Tomioka, Y.; Yanagawa, Y.; Yoshida, H.; Adnan, S.; Hasan, M.S.; Sulaiman, H.; Gasca Lopez, G.A.; Hernández-Cárdenas, C.M.; Ñamendys-Silva, S.A.; Bethlehem, C.; de Lange, D.; Hunfeld, N.; Numan, S.; van Leeuwen, H.; Owens, D.; Almeida, M.; Fragoso, E.; Leonor, T.; Pereira, J.-M.; Filipescu, D.; Grigoras, I.; Popescu, M.; Tomescu, D.; Alshahrani, M.S.; Alvarez-Gonzalez, M.; Barrero-García, I.; Blasco-Navalpotro, M.A.; Claverias, L.; Estella, Á.; Espina, L.F.; Garmendia, J.L.G.; Prieto, E.G.; Gómez-Prieto, G.; Conde, C.J.; Sagasti, F.M.; Cantero, A.M.; Orejas-Gallego, A.; Papiol, E.; Pérez-Civantos, D.; Laderas, J.C.P.; Álvarez, J.T.; Vera-Artázcoz, P.; Cortés, P.V.; Oldner, A.; Spångfors, M.; Alp, E.; Köksal, I.; Korten, V.; Özveren, A.; Hall, A.; Hatton, K.W.; Laudanski, K.; DIANA study group;

doi: 10.1007/s00134-020-06111-5

pmid: 32519003

pmc: PMC7334278

handle: 10668/15716 , 10261/238745 , https://repository.ubn.ru.nl/handle/2066/225430 , 2066/225430 , 11388/244545 , 10807/164705 , 10447/423682 , 11380/1208772 , 11392/2471335 , 1854/LU-8672662

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

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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.

Countries

Belgium, Australia, Belgium, Netherlands, United Kingdom, Italy, Italy, Netherlands, France, Greece, France, Italy, France, Netherlands, Belgium, Italy, Italy

Related Organizations

Spanish National Research Council
Spain
Radboud University Nijmegen
Netherlands
Aix-Marseille University
France
Queensland University of Technology
Australia
University of Paris
France

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Keywords

Original, Anti-Infective Agents/therapeutic use, Terapéutica, DELPHI METHOD, Curación en homeopatía, GUIDELINES, Critical Care and Intensive Care Medicine, Carbapenémicos, Anti-Infective Agents, Bacterial infections, Medicine and Health Sciences, Antimicrobial de-escalation, EPIDEMIOLOGY, DIANA study group, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Antimicrobial de-escalation; Bacterial infection; Clinical cure; Empirical therapy; Intensive care unit., Estudio observacional, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, PREVALENCE, Anti-Bacterial Agents, Intensive Care Units, STEWARDSHIP PROGRAM, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antimicrobial de-escalation; Bacterial infection; Clinical cure; Empirical therapy; Intensive care unit;, 2706 Critical Care and Intensive Care Medicine, Life Sciences & Biomedicine, [SDV.MP.PAR] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Clinical cure, Antimicrobial de-escalation; Bacterial infection; Clinical cure; Empirical therapy; Intensive care unit, Adult, Infecciones bacterianas, Critical Illness, 610, Observational Study, ANTIBIOTIC-THERAPY, 1117 Public Health and Health Services, Critical Care Medicine, BETA-LACTAM, General & Internal Medicine, 616, Journal Article, Humans, Intensive care unit, Science & Technology, VENTILATOR-ASSOCIATED PNEUMONIA, R-PACKAGE, SEPTIC SHOCK, bacterial infection, 3202 Clinical sciences, 1103 Clinical Sciences, Emergency & Critical Care Medicine, Empirical therapy, SEVERE SEPSIS, Anti-Bacterial Agents/therapeutic use, Carbapenems, Mortalidad, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Bacterial infection, Radboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences, Probabilidad

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