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Table 1 Definitions and clarification of selected CDC 12-step recommendations

From: Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: a retrospective cohort study

CDC Step Clarification
Step 4: Target the pathogen Inappropriate empiric antibiotic choice based on the likely pathogen
Inappropriate definitive antibiotic choice based on identified pathogen susceptibility (need for de-escalation)
Step 6: Practice antimicrobial control Inappropriate prophylaxis regimen (drug or duration)
Inappropriate antibiotic combination (redundant coverage)
Inappropriate route of administration (requiring a shift from intravenous administration to oral)
Inappropriate dose of antibiotic (based on indication, renal function, etc.) (not assessed in this study)
Step 8: Treat infection, not contamination or colonization Treating contamination or colonization and not a true, lab-confirmed confirmed infection
Step 9: Know when to say ‘no’ Starting empirical vancomycin or broad-spectrum antibiotics (e.g. meropenem, piperacillin/tazobactam, or ceftazidime) unnecessarily
Step 10: Stop infection when cured or unlikely Continuing antibiotics despite ruling out infection or having negative cultures or completing an appropriate duration of therapy