De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis.

Abstract

OBJECTIVE:

To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock.

METHODS:

We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library. The search terms used were "sepsis," "septic shock" and "de-escalation." The relative risk (RR) with 95% confidence intervals (CI) was used to evaluate the impact of de-escalation therapy on clinical outcomes.

RESULTS:

Nine individual studies (1873 patients) were included. Mortality trended lower in the de-escalation group as compared with the continuation of broad-spectrum antibiotics group. However, the results were not statistically significant (RR = 0.74, 95% CI 0.54-1.03).

CONCLUSION:

Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.

• Authors: Ying Guo, Wei Gao, Hongxia Yang, Cheng'en Ma, Shujian Sui
• Journal: Heart & lung : the journal of critical care (Heart Lung) 2016 Sep-Oct Vol. 45 Issue 5 Pg. 454-9 ISSN: 1527-3288 [Electronic] United States
• PMID: 27340006 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (administration & dosage)
• Global Health
• Humans
• Sepsis (drug therapy, mortality)
• Shock, Septic (drug therapy, mortality)
• Survival Rate (trends)
• Withholding Treatment (standards)