De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock

Cochrane Database of Systematic Reviews

Volumn 2013, Issue 3, 2013, Pages

  Silva, Brenda N G ^a   Andriolo, Régis B ^b   Atallah, Álvaro N ^a   Salomão, Reinaldo ^c  

^a Brazilian Cochrane Center   (Brazil)

^b UNIVERSIDADE DO ESTADO DO PARÁ   (Brazil)

^c FEDERAL UNIVERSITY OF SÃO PAULO   (Brazil)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT;

ANTIBIOTIC RESISTANCE; ANTIBIOTIC THERAPY; ANTIMICROBIAL THERAPY; CONFIDENCE INTERVAL; DE ESCALATION ANTIMICROBIAL THERAPY; DISEASE SEVERITY; DRUG EFFICACY; DRUG SAFETY; FOLLOW UP; HOSPITAL DISCHARGE; HUMAN; LIVER TOXICITY; MORTALITY; NEPHROTOXICITY; OUTCOME ASSESSMENT; PRACTICE GUIDELINE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK FACTOR; SEPSIS; SEPTIC SHOCK; SYSTEMATIC REVIEW; ADULT; TREATMENT WITHDRAWAL;

ADULT; ANTI-BACTERIAL AGENTS; HUMANS; SEPSIS; SHOCK, SEPTIC; WITHHOLDING TREATMENT;

MLCS; MLOWN;

EID: 84880055159     PISSN: None     EISSN: 1469493X     Source Type: Journal    
DOI: 10.1002/14651858.CD007934.pub3     Document Type: Review

References (118)

1. Bailey RR, Begg EJ, Smith AH, Robson RA, Lynn KL, Chambers ST, et al. Prospective, randomized, controlled study comparing two dosing regimens of gentamicin/oral ciprofloxacin switch therapy for acute pyelonephritis. Clinical Nephrology 1996;46(3):183-6. [PUBMED: 8879853]
2. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010;375(9713):463-74. [: NCT00472667; PUBMED: 20097417]
3. Bergmans DC, Bonten MJ, Gaillard CA, van Tiel FH, van der Geest S, de Leeuw PW, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. Journal of Antimicrobial Chemotherapy 1997;39(4):527-35. [PUBMED: 9145828]
4. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004;363(9409):600-7. [: NCT00407147; PUBMED: 14987884]
5. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Critical Care Medicine 2003;31(12):2742-51. [PUBMED: 14668610]
6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine 1985;13(10):818-29. [PUBMED: 3928249]
7. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Critical Care 1999;3(1):45-50. [PUBMED: 11056723]
8. Rau B, Steinbach G, Gansauge F, Mayer JM, Grunert A, Beger HG. The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 1997;41(6):832-40. [PUBMED: 9462219 ]
9. Roder BL, Nielsen SL, Magnussen P, Engquist A, Frimodt-Moller N. Antibiotic usage in an intensive care unit in a Danish university hospital. Journal of Antimicrobial Chemotherapy 1993;32(4):633-42. [PUBMED: 8288506]
10. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274(8):639-44. [PUBMED: 7637145]
11. Horisberger T, Harbarth S, Nadal D, Baenziger O, Fischer JE. G-CSF and IL-8 for early diagnosis of sepsis in neonates and critically ill children - safety and cost effectiveness of a new laboratory prediction model: study protocol of a randomized controlled trial [ISRCTN91123847]. Critical Care 2004;8(6):R443-50. [PUBMED: 15566590]
12. Jensen JU, Hein L, Thornberg K, Loeken J, Tousi H, Larsen KM, et al. Dynamic use of procalcitonin in the intensive care unit. International Journal of Intensive Care 2007;14(2):52-7.
13. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Critical Care Medicine 2006;34(10):2596-602. [PUBMED: 16915118]
14. Jensen JU, Lundgren B, Hein L, Mohr T, Petersen PL, Andersen LH, et al. The Procalcitonin And Survival Study (PASS) - a randomised multi-center investigator-initiated trial to investigate whether daily measurements biomarker Procalcitonin and pro-active diagnostic and therapeutic responses to abnormal Procalcitonin levels, can improve survival in intensive care unit patients. Calculated sample size (target population): 1000 patients. BMC Infectious Disease 2008;8:91. [: NCT00271752; PUBMED: 18620598]
15. Jensen JU, Lundgren B, Lundgren JD. Meta-analysis of procalcitonin for sepsis detection. Lancet Infectious Diseases 2007;7(8):499-500. [PUBMED: 17646020]
16. Jensen JU, Lundgren JD. Procalcitonin in liver transplant patients - yet another stone turned. Critical Care 2008;12(1):108. [PUBMED: 18254924]
17. Mabasa V, Keenan S, Wiens M, Kangura S. Standard vs adjusted dosing of piperacillin/tazobactam in acute renal failure and septic shock. http://www.controlled-trials.com/mrct/trial/477949/NCT00816790 2009.
18. Masaoka T, Hasegawa H, Takaku F, Mizoguchi H, Asano S, Ikeda Y, et al. The efficacy of intravenous immunoglobulin in combination therapy with antibiotics for severe infections. Japanese Journal of Chemotherapy 2000;48(3):199-217. [CENTRAL: CN-00418781]
19. Roberts JA, Roberts MS, Robertson TA, Dalley AJ, Lipman J. Piperacillin penetration into tissue of critically ill patients with sepsis--bolus versus continuous administration?. Critical Care Medicine 2009;37(3):926-33. [CENTRAL: CN-00684456]
20. Hochreiter M, Köhler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Critical Care 2009;13(3):R83. [PUBMED: 19493352]
21. Schroeder S, Hochreiter M, Koehler T, Schweiger AM, Bein B, Keck FS, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbeck's Archives of Surgery / Deutsche Gesellschaft für Chirurgie 2009;394(2):221-6. [CENTRAL: CN-00703948]
22. van den Anker JN, Schoemaker RC, van der Heijden BJ, Broerse HM, Neijens HJ, de Groot R. Once-daily versus twice-daily administration of ceftazidime in the preterm infant. Antimicrobial Agents and Chemotherapy 1995;39(9):2048-50. [CENTRAL: CN-00119763; PUBMED: 8540714]
23. Vuori-Holopainen E, Peltola H, Kallio MJ. Narrow- versus broad-spectrum parenteral anatimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime. European Journal of Pediatrics 2000;159(12):878-84. [PUBMED: 11131342]
24. De-escalation of Empirical Antimicrobial Therapy Study in Severe Sepsis. Ongoing study October 2011.
25. Adukauskiene D, Vitkauskiene A. Empiric de-escalation strategy of antibiotic treatment [Empirinis plataus antimikrobinio veikimo gydymas]. Medicina (Kaunas) 2006;42(9):703-8. [PUBMED: 17028467]
26. Alexandraki I, Sullivan R, Zaiden R, Bailey C, McCarter Y, Khan A, et al. Blood culture isolates in hemodialysis vascular catheter-related bacteremia. American Journal of the Medical Sciences 2008;336(4):297-302. [PUBMED: 18854670]
27. Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections in a neonatal intensive care unit. Infection Control and Hospital Epidemiology 2004;25(9):735-41. [PUBMED: 15484797]
28. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal Respiratory and Critical Care Medicine 2005;171(4):388-416. [PUBMED: 15699079]
29. Bagshaw SM, Lapinsky S, Dial S, Arabi Y, Dodek P, Wood G. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Medicine 2009;35(5):871-81. [PUBMED: 19066848]
30. Balk RA. Optimum treatment of severe sepsis and septic shock: Evidence in support of the recommendations. Disease-a-Month 2004;50(4):168-213. [PUBMED: 15133467]
31. Berild D, Mohseni A, Diep LM, Jensenius M, Ringertz SH. Adjustment of antibiotic treatment according to the results of blood cultures leads to decreased antibiotic use and costs. Journal of Antimicrobial Chemotherapy 2006;52(2):326-30. [PUBMED: 16387751]
32. Bone RC, Sprung CL, Sibbald WJ. Definitions for sepsis and organ failure. Critical Care Medicine 1992;20(6):724-6. [PUBMED: 1600757]
33. Brunkhorst FM, Reinhart K. Diagnosis and causal treatment of sepsis [Diagnose und kausale Therapie der Sepsis]. Der Internist 2009;50(7):810-6. [PUBMED: 19506808]
34. Carcelero E, Soy D. Antibiotic dose adjustment in the treatment of MRSA infections in patients with acute renal failure undergoing continuous renal replacement therapies. Enfermedades Infecciosas y Microbiología Clínica 2012;30(5):249-56. [PUBMED: 22130573]
35. Cattoir V, Daurel C. Update on antimicrobial chemotherapy [Quelles nouveautés en antibiothérapie ?]. Medecine et Maladies Infectieuses 2010;40(3):135-54. [PUBMED: 19959306]
36. Cheadle WG. Current perspectives on antibiotic use in the treatment of surgical infections. American Journal of Surgery 1992;164(4A Suppl):44S-7S. [PUBMED: 1443360]
37. Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, et al. Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Critical Care Medicine 2007;35(11):2538-46. [PUBMED: 17828034]
38. Colardyn F. Appropriate and timely empirical antimicrobial treatment of icu infections--a role for carbapenems. Acta Clinica Belgica 2005;60(2):51-62. [PUBMED: 16082989]
39. Cordero L, Ayers LW. Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants. Infection Control and Hospital Epidemiology 2003;24(9):662-6. [PUBMED: 14510248]
40. Cunha BA. Sepsis and septic shock: selection of empiric antimicrobial therapy. Critical Care Clinics 2008;24(2):313-34, ix. [PUBMED: 18361948]
41. Darby JM, Linden P, Pasculle W, Saul M. Utilization and diagnostic yield of blood cultures in a surgical intensive care unit. Critical Care Medicine 1997;25(6):989-94. [PUBMED: 9201052]
42. De Angelis G, Restuccia G, Di Muzio F, Cipriani M, Milozzi E, Cauda R, et al. Evidence-based recommendations for antibiotic usage in the intensive care unit: A systematic review. Clinical Microbiology and Infection 2011;17:S358.
43. de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003;362(9389):1011-6. [PUBMED: 14522530]
44. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Medicine 2008;34(1):17-60. [PUBMED: 18058085]
45. Deresinski S. Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. Clinical Infectious Diseases 2007;45 Suppl 3:177-83. [PUBMED: 17712744]
46. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Critical Care Medicine 2007;35(5):1244-50. [PUBMED: 17414736]
47. Dougnac AL, Mercado MF, Cornejo RR, Cariaga MV, Hernández GP, Andresen MH, et al. Prevalence of severe sepsis in intensive care units. A national multicentric study [Prevalencia de sepsis grave en las Unidades de Cuidado Intensivo. Primer estudio nacional multicéntrico]. Revista Médica de Chile 2007;135(5):620-30. [PUBMED: 17657331]
48. Drekonja DM, Johnson JR. Urinary Tract Infections. Primary Care - Clinics in Office Practice 2008;35(2):345-67. [PUBMED: 18486719]
49. Erlandsson M, Burman LG, Cars O, Gill H, Nilsson LE, Walther SM, et al. Prescription of antibiotic agents in Swedish intensive care units is empiric and precise. Scandinavian Journal of Infectious Diseases 2007;39(1):63-9. [PUBMED: 17366015]
50. Filius PM, Gyssens IC. Impact of increasing antimicrobial resistance on wound management. American Journal of Clinical Dermatology 2002;3(1):1-7. [PUBMED: 11817964]
51. Fluckiger U, Zimmerli W, Sax H, Frei R, Widmer AF. Clinical impact of an infectious disease service on the management of bloodstream infection. European Journal of Clinical Microbiology and Infectious Diseases 2000;19(7):493-500. [PUBMED: 10968319]
52. Galal AM, Gul W, Noreddin AM, Slade D. An update on the synthesis and antibacterial effects of carbapenems. Recent Patents on Anti-infective Drug Discovery 2010;5(1):23-43. [PUBMED: 19929840]
53. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empiric antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Critical Care Medicine 2003;31(12):2742-51. [PUBMED: 14668610]
54. Glowacki RC, Schwartz DN, Itokazu GS, Wisniewski MF, Kieszkowski P, Weinstein RA. Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clinical Infectious Diseases 2003;37(1):59-64. [PUBMED: 12830409]
55. Gomes Silva BN, Andriolo RB, Atallah AN, Salomão R. De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic Reviews 2010;8(12):CD007934. [PUBMED: 21154391]
56. Guillon H, Eb F, Mammeri H. Characterization of CSP-1, a novel extended-spectrum beta-lactamase produced by a clinical isolate of Capnocytophaga sputigena. Antimicrobial Agents and Chemotherapy 2010;54(5):2231-34. [PUBMED: 20308380]
57. Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. American Journal of Medicine 2003;115(7):529-35. [PUBMED: 14599631]
58. Heenen S, Jacobs F, Vincent JL. Antibiotic strategies in severe nosocomial sepsis: why do we not de-escalate more often?. Critical Care Medicine 2012;40(5):1404-9. [PUBMED: 22430235]
59. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002; Vol. 21, issue 11:1539-28. [PUBMED: 12111919]
60. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March, 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
61. Hitt CM, Nightingale CH, Quintiliani R, Nicolau DP. Streamlining antimicrobial therapy for lower respiratory tract infections. Clinical Infectious Diseases 1997;24 Suppl 2:231-7. [PUBMED: 9126698]
62. Höffken G, Niederman MS. Nosocomial pneumonia: The importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest 2002;122:2183-96. [PUBMED: 12475862 ]
63. Infectious Diseases Society of America. Bad bugs, no drugs. As antibiotic discovery stagnates a public health crisis brews. http://www.idsociety.org/badbugsnodrugs.html. Alexandria: Infectious Diseases Society of America, 2004.
64. Infectious Diseases Society of America. Principles and strategies intended to limit the impact of antimicrobial resistance. http://www.idsociety.org/Content.aspx?id=6252 2006.
65. Iñigo J, Sendra JM, Díaz R, Bouza C, Sarría-Santamera A. Epidemiology and costs of severe sepsis in Madrid. A hospital discharge study [Epidemiología y costes de la sepsis grave en Madrid. Estudio de altas hospitalarias]. Medicina Intensiva 2006;30(5):197-203. [PUBMED: 16938192]
66. Kielstein JT, Burkhardt O. Dosing of antibiotics in critically ill patients undergoing renal replacement therapy. Current Pharmaceutical Biotechnology 2011;12(12):2015-9. [PUBMED: 21554216]
67. Kollef MH. Hospital-acquired pneumonia and de-escalation of antimicrobial treatment. Critical Care Medicine 2001;29(7):1473-5. [PUBMED: 11445712]
68. Kollef MH. Providing appropriate antimicrobial therapy in the intensive care unit: surveillance vs. de-escalation. Critical Care Medicine 2006;34(3):903-5. [PUBMED: 16505677]
69. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006;34(6):1589-96. [PUBMED: 16625125]
70. Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009;136(5):1237-48. [PUBMED: 19696123]
71. Kumar A. Optimizing antimicrobial therapy in sepsis and septic shock. Critical Care Nursing Clinics of North America 2011;23(1):79-97. [PUBMED: 21316569]
72. Lane DR, Takhar SS. Diagnosis and management of urinary tract infection and pyelonephritis. Emergency Medicine Clinics of North America 2011;29(3):539-52. [PUBMED: 21782073]
73. Latour J, Abraira V, Cabello JB, López Sánchez J. Investigation methods in clinical cardiology. IV. Clinical measurements incardiology: validity and errors of measurements [Las mediciones clínicas en cardiología: validez y errores de medición]. Revista Española de Cardiología 1997;50(2):117-28. [PUBMED: 9091999 ]
74. Leone M, Garcin F, Bouvenot J, Boyadjev I, Visintini, Albanèse J, et al. Ventilator-associated pneumonia: Breaking the vicious circle of antibiotic overuse. Critical Care Medicine 2007;35(2):379-85. [PUBMED: 17205011]
75. Leone M, Martin C. How to break the vicious circle of antibiotic resistances?. Current Opinion in Critical Care 2008;14(5):587-92. [PUBMED: 18787454]
76. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Medicine 2003;29(4):530-8. [PUBMED: 12664219]
77. Liew YX, Chlebicki MP, Lee W, Hsu LY, Kwa AL. Use of procalcitonin (PCT) to guide discontinuation of antibiotic use in an unspecified sepsis is an antimicrobial stewardship program (ASP). European Journal of Clinical Microbiology & Infectious Diseases 2011;30(7):853-5. [PUBMED: 21279532]
78. Lipman J, Boots R. A new paradigm for treating infections: "go hard and go home" initiation of antimicrobial therapy. Critical Care and Resuscitation 2009;35(5):871-81. [PUBMED: 20001878]
79. Malacarne P, Rossi C, Bertolini G. Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study. Journal of Antimicrobial Chemotherapy 2004;54(1):221-4. [PUBMED: 15190030]
80. Masterton RG. Antibiotic de-escalation. Critical Care Clinics 2011;27(1):149-62. [: 21144991]
81. MacArthur RD, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, et al. Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Clinical Infectious Diseases 2004;38(2):284-8. [PUBMED: 14699463]
82. McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Archives of Internal Medicine 2009;169(16):1525-31. [PUBMED: 19752411]
83. McNulty C, Logan M, Donald IP, Ennis D, Taylor D, Baldwin RN, et al. Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy. Journal of Antimicrobial Chemotherapy 1997;40(5):707-11. [PUBMED: 9421320]
84. Miano TA, Powell E, Schweickert WD, Morgan S, Binkley S, Sarani B. Effect of an antibiotic algorithm on the adequacy of empiric antibiotic therapy given by a medical emergency team. Journal of Critical Care 2012;27(1):45-50. [PUBMED: 21798704]
85. Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrobial Agents Chemotherapy 2005;49(4):1306-11. [PUBMED: 15793102]
86. Moher D, Schulz KF, Altman D, CONSORT Group. The CONSORT Statement: revised recommendations for improving the quality of reports of parallel-group randomized trials 2001. Explore (NY) 2005;1(1):40-5. [PUBMED: 16791967]
87. Mol PG, Denig P, Gans RO, Nannanpanday PV, Degener JE, Laseur M, Haaijer-Ruskamp FM. Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines. European Journal of Clinical Pharmacology 2006;62(4):297-305. [PUBMED: 16432716]
88. Morel J, Casoetto J, Jospe R, Aubert G, Terrana R, Dumont A, et al. De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit. Critical Care 2010;14(6):R225. [PUBMED: 21167047]
89. Mutlu GM, Wunderink RG. Severe pseudomonal infections. Current Opinion in Critical Care 2006;12(5):458-63. [PUBMED: 16943726]
90. Napolitano Severe soft tissue infections. Infectious Disease Clinics of North America 2009;23(3):571-91. [PUBMED: 19665084]
91. Niederman MS. De-escalation therapy in ventilator-associated pneumonia. Current Opinion in Critical Care 2006;12(5):425-7. [PUBMED: 16943725]
92. Paul M, Silbiger I, Grozinsky S, Soares-Weiser K, Leibovici L. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD003344]
93. Pea F, Viale P. Bench-to-bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock--does the dose matter?. Critical Care 2009;13(3):214. [PUBMED: 19519961]
94. Pocock SJ. The size of a clinical trial. In: Pocock SJ editor(s). Clinical Trials, a practical approach. 1st Edition. Chichester: John Wiley & Sons, 1983:123-41.
95. Proulx N, Fréchette D, Toye B, Chan J, Kravcik S. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Quarterly Journal of Medicine 2005;98(4):291-8. [PUBMED: 15760921]
96. Raisch DW, Bootman JL, McGhan WF. Association of length of stay and total hospital charges with antimicrobial regimen changes. American Journal of Hospital Pharmacy 1988;45(4):819-23. [PUBMED: 3132038]
97. Rello J, Vidaur L, Sandiumenge A, Rodríguez A, Gualis B, Boque C, et al. De-escalation therapy in ventilator-associated pneumonia. Critical Care Medicine 2004;32(11):2183-90. [PUBMED: 15640629]
98. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
99. Richards GA. The therapeutic challenge of gram-negative sepsis: Prolonging the lifespan of a scarce resource. Clinical Microbiology and Infection 2005;11 Suppl 6:18-22.
100. Rodloff AC, Goldstein EJ, Torres A. Two decades of imipenem therapy. Journal of Antimicrobial Chemotherapy 2006;58(5):916-29. [PUBMED: 16997845]
101. Sanchez C, Matamala A, Salavert M, Cuchi E, Pons M, Angles F, et al. Cotrimoxazole plus rifampicin in the treatment of staphylococcal osteoarticular infection [Cotrimoxazol más rifampicina en el tratamiento de la infección osteoarticular estafilocócica]. Enfermedades Infecciosas y Microbiologia Clinica 1997;15(1):10-3. [PUBMED: 9147500]
102. Schierbeck J, Kolmos HJ. Antibiotic strategies in the treatment of infection in critically ill patients. Ugeskrift for Laeger 207;169(8):699-702. [PUBMED: 17313920]
103. Schuler G. Antibiotic therapy of infectious endocarditis (when, with what drug, how long?) [Antibiotische Therapie der infektiösen Endokarditis (wann, womit, wie lange?)]. Zeitschrift für Kardiologie 1994;83(1):2-8.
104. Shani V, Kariv G, Muchtar E, Leibovici L, Paul M. Appropriate vs. inappropriate empirical antibiotic treatment: Systematic review and meta-analysis of effects and modifiers. Clinical Microbiology and Infection 2009;15:S46-7.
105. Shime N, Satake S, Fujita N. De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients. Infection 2011;39(4):319-25. [: 21509424]
106. Silva E, Pedro Mde A, Sogayar AC, Mohovic T, Silva CL, Janiszewski M, et al. Brazilian Sepsis Epidemiological Study (BASES study). Critical Care 2004;8(4):R251-60. [PUBMED: 15312226]
107. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. American Journal of Respiratory and Critical Care Medicine 2000;162(2 Pt1):505-11. [PUBMED: 10934078]
108. Spies C. Implementation of de-escalation algorithm in patients with ventilator-associated pneumonia at two anaesthesiological intensive care units (ICUs) of Charité. http://www.controlled-trials.com/. Berlin, 2009. [: ISRCTN80881420]
109. Teles JMM, Silva E, Westphal G, Filho RC, Machado FR. Surviving sepsis campaign in Brazil. Shock 2008;30(7):1-6. [PUBMED: 18704009]
110. Textoris J, Wiramus S, Martin C, Leone M. Antibiotic therapy in patients with septic shock. European Journal of Anaesthesiology 2011;28(5):318-24. [PUBMED: 21464717]
111. Tripathi N, Cotten CM, Smith PB. Antibiotic use and misuse in the neonatal intensive care unit. Clinics in Perinatology 2012;39(1):61-8. [PUBMED: 22341537]
112. Vallés J, Rello J, Ochagavía A, Garnacho J, Alcalá MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest 2003;125(5):1615-24. [PUBMED: 12740282]
113. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Critical Care Medicine 2006;34(2):344-53. [PUBMED: 16424713]
114. Welte T. Sepsis management -- antibiotic therapy [Antibiotikatherapie der Sepsis]. Deutsche Medizinische Wochenschrift 2004;129(48):2609-13. [PUBMED: 15558411]
115. West MA, Moore EE, Shapiro MB, Nathens AB, Cuschieri J, Johnson JL, et al. Inflammation and the host response to injury, a large-scale collaborative project: patient-oriented research core--standard operating procedures for clinical care VII--Guidelines for antibiotic administration in severely injured patients. The Journal of Trauma 2008;65(6):1511-9. [PUBMED: 19077651]
116. World Health Organization. Antimicrobial resistance. http://www.who.int/mediacentre/factsheets/fs194/en/index.html. Geneva, 2002; Vol. Fact sheet:194.
117. Zaragoza R, Peman J, Salavert M, Viudes A, Sole A, Jarque I, et al. Multidisciplinary approach to the treatment of invasive fungal infections in adult patients. Prophylaxis, empirical, preemptive or targeted therapy, which is the best in the different hosts?. Therapeutics and Clinical Risk Management 2008;4(6):1261-80. [PUBMED: 19337433]
118. Silva BNG, Andriolo RB, Atallah ÁN, Salomão R. De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic Reviews 2010;12:CD007934. [DOI: 10.1002/14651858.CD007934.pub2]