Indication, intérêts et limites de la désescalade antibiotique en réanimation

De-escalation of antibiotic therapy is a strategy aiming both to provide adequate initial antimicrobial therapy and to minimize the risk of emerging resistance. Theoretically, de-escalation was only possible in patients exhibiting, 48-72 hours after the beginning of antimicrobial treatment, positive bacteriological cultures and clinical improvement. De-escalation is a switch from an initial broad-spectrum antibiotic therapy to a specific antibiotic therapy based on microbiological data. This management strategy is now considered as the best therapeutic approach in hospital-acquired pneumonia. It could be proposed for most infectious diseases encountered in ICU, subject to know the value of microbiological testing and to be able to evaluate the clinical outcome.