Antimicrobial stewardship programmes focused on de-escalation: a narrative review of efficacy and risks

Abstract

Background and Objective: Multi-drug resistance is an increasing problem and is associated with increased morbidity and mortality. High levels of antimicrobial consumption and broad-spectrum antimicrobial use are associated with antimicrobial resistance (AMR). Studies have shown substantial antimicrobial use across intensive care units (ICUs) worldwide. International guidelines advise antibiotic de-escalation (ADE) as part of an antimicrobial stewardship programme (ASP). ADE is a strategy to decrease the spectrum of the empirical antimicrobial therapy, with the aim to reduce the ecological impact on the patient’s microbiome and reduce the emergence of AMR. Our aim was to provide an insight into the latest developments on ADE in the intensive care setting.