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.
Keywords: Antimicrobial de-escalation; Antimicrobial resistance; De-escalation; Stewardship.
Antimicrobial Resistance and Antibiotic Stewardship Programs in the ICU: Insistence and Persistence in the Fight Against Resistance. A Position Statement From ESICM/ESCMID/WAAAR Round Table on Multi-Drug ResistanceJJ De Waele et al. Intensive Care Med 44 (2), 189-196. PMID 29288367.Antimicrobial resistance (AMR) is a clear and present danger to patients in any intensive care unit (ICU) around the world. Whereas AMR may affect any patient in the hosp …
ESICM/ESCMID Task Force on Practical Management of Invasive Candidiasis in Critically Ill PatientsI Martin-Loeches et al. Intensive Care Med 45 (6), 789-805. PMID 30911804.The heterogeneity of this patient population necessitated the creation of a mixed working group comprising experts in clinical microbiology, infectious diseases and inten …
A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care UnitA Tabah et al. Clin Infect Dis 62 (8), 1009-1017. PMID 26703860. - ReviewAntimicrobial de-escalation (ADE) is a strategy to reduce the spectrum of antimicrobials and aims to prevent the emergence of bacterial resistance. We present a systemati …
The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the Use of Antimicrobial Therapy in Complicated Intra-Abdominal Infections in the Era of Antimicrobial ResistanceN Haddad et al. BMC Infect Dis 19 (1), 293. PMID 30925909.These guidelines represent a major step towards initiating a Lebanese national antimicrobial stewardship program. The LSIDCM emphasizes on development of a national AMR s …
Management of Infections in Critically Ill Returning Travellers in the Intensive Care unit-II: Clinical Syndromes and Special Considerations in Immunocompromised PatientsJ Rello et al. Int J Infect Dis 48, 104-12. PMID 27134159. - ReviewThis position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians wit …