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An essential component of antimicrobial stewardship during the COVID-19 pandemic in the intensive care unit: de-escalation
  1. Aysel Pehlivanli1,2,3,
  2. Cigdem Ozgun4,
  3. Firdevs Gonca Sasal-Solmaz4,
  4. Didem Yuksel4,
  5. Bilgen Basgut1,2,
  6. Arif Tanju Ozcelikay5,
  7. Mustafa Necmettin Unal4
    1. 1Department of Pharmacology, Baskent University Faculty of Pharmacy, Ankara, Turkey
    2. 2Clinical Pharmacy and Drug Information Center, Baskent University Ankara Hospital, Ankara, Turkey
    3. 3Department of Clinical Pharmacy, Ankara University Faculty of Pharmacy, Ankara, Turkey
    4. 4Department of Anaesthesiology and Reanimation-ICU, Ankara University Faculty of Medicine, Ankara, Turkey
    5. 5Department of Pharmacology, Ankara University Faculty of Pharmacy, Ankara, Turkey
    1. Correspondence to Dr Aysel Pehlivanli, Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Ankara, Turkey; ayselpehlivanli{at}


    Background The antimicrobial de-escalation strategy (ADE) plays a crucial role in antimicrobial stewardship, reducing the likelihood of bacterial resistance. This study aims to evaluate how often the intensive care unit (ICU) used ADE for empirical treatment during COVID-19.

    Materials Adult ICU patients receiving empirical antimicrobial therapy for bacterial infections were retrospectively studied from September 2020 to December 2021. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of the antimicrobial to narrow the antimicrobial spectrum within the first 3 days of therapy, according to the test results and clinical picture.

    Results A total of 99 patients were included in the study. The number of patients who received empirical combined therapy (38.4%) was lower than those who received monotherapy (61.6%). The most preferred monotherapy (45.9%) was piperacillin-tazobactam, while the most preferred in combination treatment (22.7%) was meropenem. Within the first 3 days of admittance to the ICU, 3% of patients underwent ADE for their empirical antimicrobial therapy, 61.6% underwent no change, and 35.4% underwent change other than ADE. Procalcitonin levels were below 2 µg/L on the third day of treatment in 69.7% of the patients. Culture or culture-antibiogram results of 50.5% of the patients were obtained within the first 3 days of empirical therapy. There was no growth in the culture results of 21 patients (21.2%) during their ICU stay.

    Conclusion In this study, ADE practice was much lower than expected. In order to reduce the significant differences between theory and reality, clinical, laboratory, and organisational conditions must be objectively assessed along with patient characteristics.

    • Practice Guideline
    • Critical Care
    • COVID-19

    Data availability statement

    No data are available. Not applicable.

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    Data availability statement

    No data are available. Not applicable.

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