• Antonio Gutiérrez-Pizarraya, Marc Leone, Jose Garnacho-Montero, Claude Martin, and Ignacio Martin-Loeches.
• a Department of Intensive Care Medicine , Instituto de Biomedicina de Sevilla, IBIS/Hospitales Universitarios Virgen Macarena -Virgen del Rocío /CSIC/Universidad de Sevilla , Sevilla , Spain.
• Expert Rev Clin Pharmacol. 2017 Apr 1; 10 (4): 457-465.

BackgroundThere is a concern to conduct de-escalation in very sick patients.AimsTo determine if de-escalation is feasible in ICU settings.MethodsWe performed a metaanalysis of published studies conducted comparing de-escalation (defined by withdrawal of at least one antimicrobial empirically prescribed, switch to a new antimicrobial with narrower spectrum and withdrawal of at least one antimicrobial plus change of another drug to a new one with narrower spectrum) in non-immunocompromised patients with sepsis admitted to ICU.ResultsEight hundred and seventeen patients with severe sepsis or septic shock were evaluated. De-escalation was applied in 274 patients (33.5%). We found no differences in hospital long of stay between de-escalation group compared to those who did not receive it. We also found significant lower hospital mortality in de-escalation group as compared with no modification group in front of the others (25.9 vs. 43.1%; p < 0.001). Taking into account the etiology of infection, in both gram negative and gram positives microorganisms, de-escalation strategy was assessed as a good prognosis factor for mortality in the adjusted multivariate analysis (OR 0.41; 95% CI 0.22-0.74 and OR 0.33; 95% CI 0.15-0.70 respectively) whereas SOFA score along with age were found as a factors independently associated with a worse clinical outcome (OR 1.23; 95% CI 1.12-1.35 and OR 1.02; 95% CI 1.01-1.04 respectively).ConclusionsIn our study there was an independent association of de-escalation and decrease mortality rate.

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