A Prospective Observational Study on Antibiotic De-escalation Practices and Outcomes in ICU Patients with Suspected or Confirmed Infections

This prospective observational study evaluates antibiotic de-escalation practices and associated outcomes in adult ICU patients with suspected or confirmed infections receiving broad spectrum antibiotics. Conducted in the medical and surgical ICUs of Tata Memorial Hospital and ACTREC, the study includes adults admitted to ICU for more than 48 hours who receive broad-spectrum antibiotics within the first 48 hours of admission. ADE is defined as narrowing antibiotic spectrum, stopping combination agents, or discontinuing empiric coverage for non-isolated pathogens.

The primary outcome is the rate of ADE, while secondary outcomes include early discontinuation of antibiotics, duration of therapy, factors influencing ADE decisions, ICU and hospital length of stay, mortality, and incidence of Clostridium difficile infection. Patients are followed until ICU discharge or death, with data collected on demographics, severity scores, microbiology, and antibiotic use. The study aims to generate real-world evidence on ADE frequency, safety, and clinical impact in ICU settings, supporting antimicrobial stewardship efforts