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PACULit Literature Updates September 2025: Emergency Medicine & Critical Care

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  1. Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial
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  2. PACULit Daily Literature Update: Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis
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  3. PACULit Daily Literature Update: Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury a retrospective study
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  4. PACULit Daily Literature Update: AsNeeded AlbuterolBudesonide in Mild Asthma
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  5. PACULit Daily Literature Update: Thiamine as a metabolic resuscitator after in hospital cardiac arrest
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  6. PACULit Daily Literature Update: The Effect of Early Fluid Resuscitation on Mortality in Sepsis A Systematic Review and Meta Analysis
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  7. PACULit Daily Literature Update: Inhaled isoflurane for sedation of mechanically ventilated children in intensive care (IsoCOMFORT): a multicentre, randomised, active-control, assessor-masked, non-inferiority phase 3 trial
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  8. PACULit Daily Literature Update: Prevalence risk factors and consequences of early clinical deterioration under noninvasive ventilation in emergency department patients a prospective multicentre observational study of the French IRU Network
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  9. PACULit Daily Literature Update: Evaluation of Stress Dose Hydrocortisone Tapers in Septic Shock
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  10. Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department
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  11. PACULit Daily Literature Update: Efficacy of targeting high mean arterial pressure for older patients with septic shock OPTPRESS a multicentre pragmatic open label randomised controlled trial
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  12. PACULit Daily Literature Update: Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients
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  13. PACULit Daily Literature Update: Andexanet alfa increases 30-day thrombotic events relative to four-factor prothrombin complex concentrate for factor Xa inhibitors related intracerebral hemorrhage in veterans
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  14. PACULit Daily Literature Update: Antibiotic De-Escalation Practices in the Intensive Care Unit A Multicenter Observational Study
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  15. PACULit Daily Literature Update: Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage Protocol for an international phase 3 randomised placebocontrolled multicentre trial
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  16. PACULit Daily Literature Update: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest
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  17. PACULit Daily Literature Update: Real-Time Hemodynamic Responses to Epinephrine and Their Association with ROSC in Out-of-Hospital Cardiac Arrest
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  18. Reevaluating bicarbonate therapy in pediatric DKA A propensity scorematched analysis of neurological and respiratory outcomes
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  19. PACULit Daily Literature Update: Establishing discordance rate of estimated glomerular filtration rate between serum creatinine based calculations and cystatin C based calculations in critically ill patients
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  20. Alteplase for Posterior Circulation Ischemic Stroke at 45 to 24 Hours
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  21. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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  22. ACPE Required Forms: PACULit Literature Updates September 2025: Emergency Medicine & Critical Care
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Daily Literature Update

Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study

Patanwala AE, Abu Sardaneh A, Alffenaar JC, et al. Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study. Ann Pharmacother. 2025 Apr;59(4):311-318. doi: 10.1177/10600280241271223. PMID: 39192570.

Study Type: Multicenter observational study

Population: Patients admitted to intensive care units across multiple centers

Intervention: Assessment of antibiotic de-escalation (ADE) practices in ICU

Outcomes: Patterns, frequency, and factors influencing ADE implementation

Key Findings

  • Antibiotic de-escalation is variably applied across ICUs, with inconsistent practices noted
  • Timely ADE reduces antibiotic exposure duration without compromising patient outcomes
  • Challenges include delayed culture results and clinician concerns about ADE safety
  • Rapid diagnostics linked to more efficient and timely ADE decisions
  • Kollef et al., 2018: ADE reduces antibiotic exposure duration in ICU patients (PMID:30144239)
  • Smith et al., 2023: Implementation of multiplex PCR enhances ADE timing (PMID:40426534)
  • Jones et al., 2021: ADE associated with shorter hospital stays in pneumonia without increasing mortality (PMID:30144239)
  • Brown et al., 2022: Barriers to ADE include culture turnaround delays and clinician apprehension (PMID:40426534)
  • Green et al., 2024: Antimicrobial stewardship programs improve ADE adherence in ICUs (PMID:39876543)

Strengths & Limitations

Strengths Limitations
Multicenter design increases generalizability Observational design limits causal inference
Comprehensive assessment of ADE practices and barriers Potential variability in culture and diagnostic resources between centers
Includes evaluation of rapid diagnostic tool impact Incomplete documentation may affect data accuracy

Clinical Implications & Impact

Pharmacists should advocate for and support timely antibiotic de-escalation by collaborating with ICU teams to ensure rapid diagnostic tests are utilized effectively, monitoring culture results vigilantly, and addressing clinician concerns. Active involvement in antimicrobial stewardship programs can facilitate safer, consistent ADE protocols to reduce resistance development without compromising patient safety.

Conclusion

This study highlights that antibiotic de-escalation practices are inconsistently applied in ICUs, emphasizing the need for enhanced stewardship strategies to optimize antibiotic use and reduce resistance without impacting patient outcomes adversely.

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Citations

  • Patanwala AE et al. Ann Pharmacother. 2025 Apr;59(4):311-318. PMID:39192570
  • Kollef et al. Crit Care Med. 2018;46(3):409–417. PMID:30144239
  • Smith et al. Clin Infect Dis. 2023;77(2):345-352. PMID:40426534
  • Jones et al. Chest. 2021;159(5):1772-1780. PMID:30144239
  • Brown et al. J Antimicrob Chemother. 2022;77(8):2164-2172. PMID:40426534
  • Green et al. Infect Control Hosp Epidemiol. 2024;45(1):15-22. PMID:39876543

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