Most infectious diseases physicians and intensivists would agree that de-escalation of antibiotics is a good thing. Trimming unnecessary antibiotic use could enhance safety for the patient and potentially decrease the risk of drug resistant pathogens to others in the environment.Although the above is sensible and biologically plausible, can we prove this?
Sadly, the medical literature suggests that we have a long way to go in our efforts to be convincing antibiotic stewards. Take a peak at this systematic review on antimicrobial de-escalation in the ICU, published in Clinical Infectious Diseases. First, there is no uniform definition of antibiotic de-escalation. Second, we have yet to prove that de-escalation impacts bacterial resistance patterns, antimicrobial cost, length of stay and patient outcomes.
These huge knowledge gaps significantly limit the ability of antimicrobial stewardship programs to affect change and measure success.
Daunting.
