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

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.; Sjovall, 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.; Arevalo, E. P.; Crespo, M.; Flores, R. Z.; Piza, 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.; Mandala, 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.; Hernandez-Cardenas, C. M.; Namendys-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-Garcia, I.; Blasco-Navalpotro, M. A.; Claverias, L.; Estella, A.; Espina, L. F.; Garmendia, J. L. G.; Prieto, E. G.; Gomez-Prieto, G.; Conde, C. J.; Sagasti, F. M.; Cantero, A. M.; Orejas-Gallego, A.; Papiol, E.; Perez-Civantos, D.; Laderas, J. C. P.; Alvarez, J. T.; Vera-Artazcoz, P.; Cortes, P. V.; Oldner, A.; Spangfors, M.; Alp, E.; Koksal, I.; Korten, V.; Ozveren, A.; Hall, A.; Hatton, K. W.; Laudanski, K.

doi:10.1007/s00134-020-06111-5

Purpose: 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. Methods: 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. Results: 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). Conclusion: 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.

Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study / 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.; Sjovall, 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.; Arevalo, E. P.; Crespo, M.; Flores, R. Z.; Piza, 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.; Mandala, 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.; Hernandez-Cardenas, C. M.; Namendys-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-Garcia, I.; Blasco-Navalpotro, M. A.; Claverias, L.; Estella, A.; Espina, L. F.; Garmendia, J. L. G.; Prieto, E. G.; Gomez-Prieto, G.; Conde, C. J.; Sagasti, F. M.; Cantero, A. M.; Orejas-Gallego, A.; Papiol, E.; Perez-Civantos, D.; Laderas, J. C. P.; Alvarez, J. T.; Vera-Artazcoz, P.; Cortes, P. V.; Oldner, A.; Spangfors, M.; Alp, E.; Koksal, I.; Korten, V.; Ozveren, A.; Hall, A.; Hatton, K. W.; Laudanski, K.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 46:7(2020), pp. 1404-1417. [10.1007/s00134-020-06111-5]

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

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.;Sjovall 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.;Arevalo E. P.;Crespo M.;Flores R. Z.;Piza 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.;Mandala 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.;Hernandez-Cardenas C. M.;Namendys-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-Garcia I.;Blasco-Navalpotro M. A.;Claverias L.;Estella A.;Espina L. F.;Garmendia J. L. G.;Prieto E. G.;Gomez-Prieto G.;Conde C. J.;Sagasti F. M.;Cantero A. M.;Orejas-Gallego A.;Papiol E.;Perez-Civantos D.;Laderas J. C. P.;Alvarez J. T.;Vera-Artazcoz P.;Cortes P. V.;Oldner A.;Spangfors M.;Alp E.;Koksal I.;Korten V.;Ozveren A.;Hall A.;Hatton K. W.;Laudanski K.

2020-01-01

Abstract

Purpose: 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. Methods: 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. Results: 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). Conclusion: 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.

Scheda breve

Scheda completa

Scheda completa (DC)

	Anno
	
				2020
			
	Citazione
	
				Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study / 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.; Sjovall, 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.; Arevalo, E. P.; Crespo, M.; Flores, R. Z.; Piza, 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.; Mandala, 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.; Hernandez-Cardenas, C. M.; Namendys-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-Garcia, I.; Blasco-Navalpotro, M. A.; Claverias, L.; Estella, A.; Espina, L. F.; Garmendia, J. L. G.; Prieto, E. G.; Gomez-Prieto, G.; Conde, C. J.; Sagasti, F. M.; Cantero, A. M.; Orejas-Gallego, A.; Papiol, E.; Perez-Civantos, D.; Laderas, J. C. P.; Alvarez, J. T.; Vera-Artazcoz, P.; Cortes, P. V.; Oldner, A.; Spangfors, M.; Alp, E.; Koksal, I.; Korten, V.; Ozveren, A.; Hall, A.; Hatton, K. W.; Laudanski, K.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 46:7(2020), pp. 1404-1417. [10.1007/s00134-020-06111-5]
			
	Appare nelle tipologie:
	
				1.1 Articolo in rivista

File in questo prodotto:

File	Dimensione	Formato
DeBus_DIANA_study_ICM2020.pdf accesso aperto Tipologia: Versione editoriale (versione finale pubblicata) Licenza: Creative commons Dimensione 914.55 kB Formato Adobe PDF Visualizza/Apri	914.55 kB	Adobe PDF	Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/244545

Citazioni

ND

60

56

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

2020-01-01

Abstract

Scheda breve Scheda completa Scheda completa (DC)

Informazioni

Citazioni

social impact

Conferma cancellazione

Scheda breve

Scheda completa

Scheda completa (DC)