De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis

Guo, Ying; Gao, Wei; Yang, Hongxia; Sui, Shujian

doi:10.1016/j.hrtlng.2016.06.001

Cited by 42 publications

(30 citation statements)

References 26 publications

(32 reference statements)

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“…Patients with sepsis or septic shock generally warrant empiric broad-spectrum therapy until the causative organism and its antimicrobial susceptibilities are defined. At that point, the spectrum of coverage should be narrowed by eliminating unneeded antimicrobials and replacing broad-spectrum agents with more specific agents [118]. However, if relevant cultures are negative, empiric narrowing of coverage based on a good clinical response is appropriate.…”

Section: We Recommend That Empiric Antimicrobial Therapy Be Narrowed mentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Rhodes

Evans

Alhazzani

et al. 2017

Critical Care Medicine

2,343

814

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Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

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Section: We Recommend That Empiric Antimicrobial Therapy Be Narrowed mentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Rhodes

Evans

Alhazzani

et al. 2017

Critical Care Medicine

2,343

814

View full text Add to dashboard Cite

show abstract

“…We used the search strategy described by Schuts et al [2] (Appendix 1). In addition, we checked all other available systematic reviews and meta-analyses for missed publications [5][6][7][8][9]. We selected papers evaluating the effect of deescalation on mortality (as primary or secondary outcome), which yielded 52 observational studies .…”

Section: General Characteristics Of Observational Studies Evaluating mentioning

confidence: 99%

Impact of antimicrobial de-escalation on mortality: a literature review of study methodology and recommendations for observational studies

Heijl

Schweitzer

Linden

et al. 2020

Expert Review of Anti-infective Therapy

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Introduction: The safety of de-escalation of empirical antimicrobial therapy is largely based on observational data, with many reporting protective effects on mortality. As there is no plausible biological explanation for this phenomenon, it is most probably caused by confounding by indication. Areas covered: We evaluate the methodology used in observational studies on the effects of deescalation of antimicrobial therapy on mortality. We extended the search for a recent systematic review and identified 52 observational studies. The heterogeneity in study populations was large. Only 19 (36.5%) studies adjusted for confounders and four (8%) adjusted for clinical stability during admission, all as a fixed variable. All studies had methodological limitations, most importantly the lack of adjustment for clinical stability, causing bias toward a protective effect. Expert opinion: The methodology used in studies evaluating the effects of de-escalation on mortality requires improvement. We depicted all potential confounders in a directed acyclic graph to illustrate all associations between exposure (de-escalation) and outcome (mortality). Clinical stability is an important confounder in this association and should be modeled as a time-varying variable. We recommend to include de-escalation as time-varying exposure and use inverse-probability-of-treatment weighted marginal structural models to properly adjust for time-varying confounders.

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“… 112 – 114 Despite the lack of evidence indicating decreased mortality, antibiotic de-escalation is safe and can be implemented in the management of septic burn patients when supported by both microbiological data and clinical judgement. 115 …”

Section: Management Of Sepsis In Burn Patientsmentioning

confidence: 99%

Predicting and managing sepsis in burn patients: current perspectives

Lopez¹,

Cambiaso‐Daniel²,

Branski³

et al. 2017

TCRM

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Modern burn care has led to unprecedented survival rates in burn patients whose injuries were fatal a few decades ago. Along with improved survival, new challenges have emerged in the management of burn patients. Infections top the list of the most common complication after burns, and sepsis is the leading cause of death in both adult and pediatric burn patients. The diagnosis and management of sepsis in burns is complex as a tremendous hypermetabolic response secondary to burn injury can be superimposed on systemic infection, leading to organ dysfunction. The management of a septic burn patient represents a challenging scenario that is commonly encountered by providers caring for burn patients despite preventive efforts. Here, we discuss the current perspectives in the diagnosis and treatment of sepsis and septic shock in burn patients.

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De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis

Cited by 42 publications

References 26 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Impact of antimicrobial de-escalation on mortality: a literature review of study methodology and recommendations for observational studies

Predicting and managing sepsis in burn patients: current perspectives

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