Clinical outcomes of carbapenem de-escalation regardless of microbiological results: A propensity score analysis

Int J Infect Dis. 2019 Aug:85:80-87. doi: 10.1016/j.ijid.2019.04.034. Epub 2019 May 7.

Abstract

Objective: The aim of this study was to evaluate the safety and efficacy of de-escalation in patients under treatment with carbapenems and its impact on clinical outcomes.

Methods: A prospective observational study was conducted for 1year. Patients administered active carbapenems for at least 24h were included. Primary outcomes were in-hospital mortality, mortality at 30 days after carbapenem prescription, and infection-related readmission within 30 days. De-escalation was defined as the substitution of carbapenem with narrower spectrum antimicrobial agents or its discontinuation during the first 96h of treatment.

Results: The study included 1161 patients, and de-escalation was performed in 667 (57.5%) of these. In the de-escalation group, 54.9% of cultures were positive. After propensity score matching, 30-day mortality was lower (17.4% vs. 25.7%, p=0.036), carbapenem treatment was 4 days shorter (4 vs. 8 days, p<0.001), total antibiotic therapy duration was 2 days longer (12 vs. 10 days, p=0.003), and length of hospital stay was 5 days shorter (8 vs. 13 days, p=0.008) in the de-escalated versus non-de-escalated patients. In-hospital mortality and 30-day readmission rates did not differ significantly between these groups.

Conclusion: Carbapenem de-escalation is a safe strategy that does not compromise the clinical status of patients.

Keywords: Antimicrobial stewardship programme; Carbapenems; De-escalation; Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteria / isolation & purification
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Bacterial Infections / mortality
  • Carbapenems / therapeutic use*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Propensity Score
  • Prospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Carbapenems