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Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP)

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Abstract

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.

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Authors and Affiliations

  1. Intensive Care Unit, Redcliffe and Caboolture Hospitals, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

    Alexis Tabah

  2. Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria Misericordia University Hospital, Udine, Italy

    Matteo Bassetti

  3. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA

    Marin H. Kollef

  4. Hygiène Hospitalière Et Prévention du Risque Infectieux, CHU Avicenne, AP-HP, 125 rue de Stalingrad, 93000, Bobigny, France

    Jean-Ralph Zahar

  5. Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Faculty of Medicine and University of Porto, Grupo de Infecçao e Sépsis, Porto, Portugal

    José-Artur Paiva

  6. Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France

    Jean-Francois Timsit

  7. University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France

    Jean-Francois Timsit

  8. University of Queensland Centre for Clinical Research, Faculty of Medicine, and Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia

    Jason A. Roberts

  9. Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Jason A. Roberts

  10. Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France

    Jason A. Roberts

  11. Department of Intensive Care, Radboudumc, Nijmegen, The Netherlands

    Jeroen Schouten

  12. 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece

    Helen Giamarellou

  13. CIBERES and Vall d’Hebron Institute of Research, Barcelona, Spain

    Jordi Rello

  14. Clinical Research in ICU, CHU Nîmes, University Montpellier, Montpellier, France

    Jordi Rello

  15. Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium

    Jan De Waele & Pieter Depuydt

  16. Medstar Washington Hospital Center, Washington DC, USA

    Andrew F. Shorr

  17. Department of Anesthesiology and Intensive Care Medicine, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France

    Marc Leone

  18. 3rd Department of Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Greece

    Garyphallia Poulakou

  19. Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain

    Jose Garnacho-Montero

Authors
  1. Alexis Tabah
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  2. Matteo Bassetti
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  3. Marin H. Kollef
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  4. Jean-Ralph Zahar
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  5. José-Artur Paiva
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  6. Jean-Francois Timsit
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  7. Jason A. Roberts
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  8. Jeroen Schouten
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  9. Helen Giamarellou
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  10. Jordi Rello
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  11. Jan De Waele
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  12. Andrew F. Shorr
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  13. Marc Leone
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  14. Garyphallia Poulakou
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  15. Pieter Depuydt
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  16. Jose Garnacho-Montero
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Corresponding author

Correspondence to Alexis Tabah.

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Conflict of interest

Dr. Tabah has nothing to disclose. Dr. Bassetti reports grants and personal fees from PFIZER, grants and personal fees from MSD, grants and personal fees from MENARINI, grants and personal fees from ANGELINI, personal fees from ASTELLAS, personal fees from NABRIVA, grants and personal fees from PARATEK, personal fees from GILEAD, personal fees from BASILEA, personal fees from CIDARA, personal fees from MOLTENI, outside the submitted work. Dr. Kollef’s efforts are supported by the Barnes-Jewish Hospital Foundation. Dr. Zahar reports personal fees from MSD, personal fees from Correvio, personal fees from Pfizer, outside the submitted work. Dr. Paiva has nothing to disclose. Dr. Timsit reports grants and personal fees from Pfizer, grants and personal fees from Merck, personal fees from Astellas, grants and personal fees from Biomerieux, personal fees from 3 M, during the conduct of the study; personal fees from Nabriva, personal fees from Bayer pharma, outside the submitted work. Dr. Roberts reports personal fees and non-financial support from Biomerieux, grants and personal fees from MSD, personal fees from Astellas, personal fees from Infectopharm, grants from The Medicines Company, outside the submitted work. Dr. Schouten has nothing to disclose. Dr. Giamarellou has received research grants from Pfizer, MSD, Angelini. Dr. Rello reports personal fees from Navriba, grants from BAYER, personal fees from Pfizer, personal fees from Anchoagen, outside the submitted work. Dr. De Waele reports grants from Research Foundation Flanders, during the conduct of the study; other from Bayer, other from Pfizer, other from MSD, other from Grifols, other from Accelerate, outside the submitted work. Dr Shorr has served as a speaker for, received research support from, or been a consultant to: Astellas, Merck, Nabriva, Paratek, Shinogi, and Tetraphase. Dr. Leone reports personal fees from MSD, personal fees from Pfizer, during the conduct of the study; grants, personal fees and non-financial support from AMOMED, personal fees from AGUETTANT, personal fees from ASPEN, personal fees from OCTAPHARMA, personal fees from ORION, outside the submitted work. Dr. Poulakou reports personal fees from Angelini, personal fees from MSD, grants and personal fees from Pfizer, grants from Roche, outside the submitted work. Dr. Depuydt has nothing to disclose. Dr. Garnacho-Montero has nothing to disclose.

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Tabah, A., Bassetti, M., Kollef, M.H. et al. Antimicrobial de-escalation in critically ill patients: a position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP). Intensive Care Med 46, 245–265 (2020). https://doi.org/10.1007/s00134-019-05866-w

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