Carbapenems De-escalation as Antimicrobial Stewardship

Chiang Mai University

Status: Completed

Conditions: Anti-Bacterial Agents

Treatments: Other: Early Carbapenem de-escalation

Study type: Interventional

Funder types: Other

Identifiers

NCT03114358

3629

Details and patient eligibility

About

Early de-escalation of carbapenems can reduce unnecessary use of carbaepenems compared with late de-escalation without compromised clinical outcomes

Full description

A cluster randomized control trial was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital.

Patients were randomly assigned into 2 groups. The standard group followed the hospital policy in which carbapenems were evaluated by ID specialist at 72 hours of admission (late de-escalation). De-escalation may occurred earlier depends upon the decision of the primary care team. The intervention group is de-escalation carbapenems early within 24 hours or no later than 72 hours of prescription by ID specialist (early de-escalation).

Clinical outcomes included rate of de-escalation within the first 24 hour, the mortality rate, and other clinical outcomes.

Enrollment: 104 patients

Sex: All

Ages: 15+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria

• All adult patients aged ≥ 15 years old
• received carbapenems (meropenem and imipenem/cilastatin) empirically within 24-72 hours for the first time during admission
• able to sign informed consent

Exclusion criteria

• They were in the intensive care units, or had neutropenia (absolute neutrophil count < 1,000 cell/mm3)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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104 participants in 2 patient groups

Early carbapenems de-escalation

Experimental group

Description:

De-escalation carbapenems within 24 hours or no later than 72 hours of prescription by Infectious disease specialist (early de-escalation).

Treatment:

Other: Early Carbapenem de-escalation

Late carbapenems de-escalation

No Intervention group

Description:

De-escalation followed the hospital policy in which carbapenems were evaluated by ID specialist at 72 hours of admission (late de-escalation). De-escalation may occurred earlier depends upon the decision of the primary care team