Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study.

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Practices surrounding antibiotic de-escalation (ADE) in intensive care units (ICUs) remain poorly understood.
• Optimizing antibiotic use is crucial for combating antimicrobial resistance and improving patient outcomes.

Purpose of the Study:

• To determine the proportion of ICU patients receiving timely ADE within 24 hours of actionable cultures.
• To identify predictors associated with the prompt implementation of ADE.

Main Methods:

• A multicenter cohort study was conducted across 15 hospitals in Australia and New Zealand.
• Adult patients initiated on broad-spectrum antibiotics within 24 hours of ICU admission were analyzed.
• ADE was defined as a switch to narrower-spectrum agents or antibiotic cessation, with the primary outcome being ADE within 24 hours of an actionable culture.

Main Results:

• Of 446 patients, 161 were ineligible for ADE and 37 had indeterminate ADE status.
• In the remaining 248 patients, 60.5% received ADE within 24 hours of actionable cultures.
• Negative culture results were a significant predictor of less timely ADE (OR = 0.48, P = 0.03).

Conclusions:

• Timely antibiotic de-escalation occurs in only 60.5% of eligible ICU patients within 24 hours.
• Patients with negative cultures are less likely to receive timely ADE, highlighting an area for antimicrobial stewardship intervention.
• Targeting patients with negative cultures for ADE can potentially improve overall antimicrobial stewardship efforts in ICUs.