Journal
HEART & LUNG
Volume 45, Issue 5, Pages 454-459Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.hrtlng.2016.06.001
Keywords
Antibiotics; Severe sepsis; Septic shock; De-escalation; Empirical
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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. (C) 2016 Elsevier Inc. All rights reserved.
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