Svetlana Sadyrbaeva-Dolgova1, Pilar Aznarte-Padial2, Juan Pasquau-Liaño3, Manuela Expósito-Ruiz4, Miguel Ángel Calleja Hernández5, Carmen Hidalgo-Tenorio3. 1. Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain. Electronic address: sadyrbaeva@gmail.com. 2. Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain. 3. Department of Infectious Disease, University Hospital, Granada, Spain. 4. Instituto de Investigación Biosanitaria de Granada, Granada, Spain. 5. Department of Pharmacy, University Hospital Virgen Macarena, Seville, Spain.
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.
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.
Authors: Yong Chan Kim; Jung Ho Kim; Jin Young Ahn; Su Jin Jeong; Nam Su Ku; Jun Yong Choi; Joon-Sup Yeom; Yoon Soo Park; Young Goo Song; Ha Yan Kim Journal: Antibiotics (Basel) Date: 2020-05-13