De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis

Objective: To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. Methods: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on The Cochrane Library. The search terms used were "sepsis," "septic shock" and "de-escalation." The relative risk (RR) with 95% confidence intervals (CI) was used to evaluate the impact of de-escalation therapy on clinical outcomes. Results: Nine individual studies (1873 patients) were included. Mortality trended lower in the de-escalation group as compared with the continuation of broad-spectrum antibiotics group. However, the results were not statistically significant (RR = 0.74, 95% CI 0.54-1.03). Conclusion: Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice. (C) 2016 Elsevier Inc. All rights reserved.