Emergencies Clinical Trial
Official title:
DetermInants of Antimicrobial Use aNd De-escalAtion in Critical Care (DIANA Study)
Appropriate initial antibiotic therapy is crucial in the treatment of severe infections in
patients with intensive care. Adequate spectrum and appropriate doses are the keys to
achieving the therapeutic goal. Despite broad consensus on the spectrum and timing of
antimicrobial therapy, antibiotic use varies according to various parameters including
choice, dose, method of administration, duration of antibiotic therapy and de-escalation. an
empirical attitude.
Therapeutic de-escalation is considered essential for the use of antibiotics and is now
clearly established by different consensus. However, routine de-escalation has recently been
questioned in a randomized, controlled study that did not demonstrate non-inferiority of
de-escalation with an increase in the number of days of antibiotic therapy associated with an
increased number of days. superinfection.
The components of the de-escalation described in the literature, are based on the reduction
of the number of antibiotics, the strict observance of the spectrum of the antibiotic, the
reduction of use of the antibiotic, the stopping of any inappropriate antibiotic treatment (
lack of in vitro activity).
De-escalation can be considered in different ways; there are significant variations between
hospitals, countries, teams. A large European multicenter cohort is needed.
The main objective of this study is to describe empiric antibiotic therapy in intensive care
and the modalities of de-escalation.
Appropriate initial antibiotic therapy is crucial in the treatment of severe infections in
patients with intensive care. Adequate spectrum and appropriate doses are the keys to
achieving the therapeutic goal. Despite broad consensus on the spectrum and timing of
antimicrobial therapy, antibiotic use varies according to various parameters including
choice, dose, method of administration, duration of antibiotic therapy and de-escalation. an
empirical attitude.
Therapeutic de-escalation is considered essential for the use of antibiotics and is now
clearly established by different consensus. However, routine de-escalation has recently been
questioned in a randomized, controlled study that did not demonstrate non-inferiority of
de-escalation with an increase in the number of days of antibiotic therapy associated with an
increased number of days. superinfection.
The components of the de-escalation described in the literature, are based on the reduction
of the number of antibiotics, the strict observance of the spectrum of the antibiotic, the
reduction of use of the antibiotic, the stopping of any inappropriate antibiotic treatment (
lack of in vitro activity).
De-escalation can be considered in different ways; there are significant variations between
hospitals, countries, teams. A large European multicenter cohort is needed.
The main objective of this study is to describe empiric antibiotic therapy in intensive care
and the modalities of de-escalation (rate of de-escalation, incidence of mortality, length of
stay in intensive care unit, relapse, rate of superinfection)
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