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De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock

  1. Brenda NG Silva1,*,
  2. Régis B Andriolo2,
  3. Álvaro N Atallah3,
  4. Reinaldo Salomão4

Editorial Group: Cochrane Anaesthesia Group

Published Online: 28 MAR 2013

Assessed as up-to-date: 31 OCT 2012

DOI: 10.1002/14651858.CD007934.pub3


How to Cite

Silva BNG, Andriolo RB, Atallah ÁN, Salomão R. De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD007934. DOI: 10.1002/14651858.CD007934.pub3.

Author Information

  1. 1

    Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica de Saúde, Brazilian Cochrane Centre, São Paulo, São Paulo, Brazil

  2. 2

    Universidade do Estado do Pará, Department of Public Health, Belém, Pará, Brazil

  3. 3

    Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde, Brazilian Cochrane Centre, São Paulo, São Paulo, Brazil

  4. 4

    Universidade Federal de São Paulo, Department of Medicine, São Paulo, São Paulo, Brazil

*Brenda NG Silva, Brazilian Cochrane Centre, Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica de Saúde, Rua Borges Lagoa, 564 cj 63, Vl. Clementino, São Paulo, São Paulo, 04038-000, Brazil. brendagomess@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 28 MAR 2013

SEARCH

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Bailey 1996Intervention not of interest: single large iv dose (10 mg/kg) of gentamicin with a standard multiple dose regimen of gentamicin.

Bouadma 2010Intervention not of interest, patients were randomized to:

  • group I, to be monitored by an inflammatory marker (procalcitonin), and thus the antibiotics were started or stopped based on predefined cut-off ranges of procalcitonin concentrations;


  • group II, control group (antibiotics according to present guidelines).


The patients were not randomized to have an initial empirical and broad-spectrum antimicrobial therapy, adjusted according to the culture results or clinical condition.

Christ-Crain 2004Intervention not of interest: patients randomized to be monitored by inflammatory marker (procalcitonin) or control group. The patients were not randomized to have their antimicrobial therapy adjusted according to the culture results or clinical condition.

Clinical condition out of area of interest: ICU patients with no obvious site of Infection.

Horisberger 2004Interventions not of interest: routine sepsis work up versus intervention strategy with additional cytokine measurements.

Clinical condition not of interest: paediatric patients.

Jensen 2008Interventions not of interest: procalcitonin measurements.

Clinical condition out of area of interest: ICU patients.

Mabasa 2009Intervention out of area of interest: participants with septic shock were randomized to have renally adjusted dosage of antibiotics.

Masaoka 2000Interventions out of area of interest: intravenous immunoglobulin in combination therapy with antibiotics versus antibiotics monotherapy.

Roberts 2009Intervention out of area of interest: different daily doses of piperacillin-tazobactam by bolus dosing or continuous infusion.

Schroeder 2009Intervention out of area of interest, patients were randomized to:

  1. be monitored by inflammatory marker (procalcitonin),
  2. control group (absence of monitoring by inflammatory markers).

van den Anker 1995Intervention not of interest (once-daily versus twice-daily administration of ceftazidime), clinical condition not of interest

(preterm infants).

Vuori-Holopainen 2000Interventions out of area of interest: procaine penicillin intramuscularly (narrow-spectrum antimicrobial) versus cefuroxime intravenously (broad-spectrum antimicrobial) for 4 to 7 days.

Clinical condition out of area of interest: common infections of childhood.

 
Characteristics of ongoing studies [ordered by study ID]
Leone 2012

Trial name or titleDe-escalation of Empirical Antimicrobial Therapy Study in Severe Sepsis

MethodsOpen label randomized controlled trial

Participants
  • Major subject.
  • Subject having a sepsis engraves (burns) defined according to the following criteria during the initiation of the probability antibiotic treatment:
  • criteria of SIRS [14 ], and
  • a suspected infection, and
  • a failure of organ: low blood pressure, respiratory failure, coma, hepatic insufficiency, renal insufficiency, thrombopenia, spontaneous extension of the TCA.
  • Subject for which an antibiotic treatment was begun within 6 hours following the diagnosis of sepsis engraves (burns).
  • Subject for which taking the microbiological aim was made within 48 hours following the diagnosis of sepsis.

Interventions1. Experimental: a strategy based on de-escalation intervention. Procedure: streamlining of the empirical antimicrobial therapy

2. Active comparator: a conservative strategy intervention. Procedure: continuation of the empirical antimicrobial therapy

Outcomes

Starting dateOctober 2011

Contact informationMarc Leone marc.leone@ap-hm.fr

Notes