Sadyrbaeva-Dolgova, SvetlanaAznarte-Padial, PilarPasquau-Liaño, JuanExpósito-Ruiz, ManuelaCalleja Hernández, Miguel ÁngelHidalgo-Tenorio, Carmen2023-01-252023-01-252019-05-07http://hdl.handle.net/10668/13939The 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. 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. 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 Carbapenem de-escalation is a safe strategy that does not compromise the clinical status of patients.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Antimicrobial stewardship programmeCarbapenemsDe-escalationExtended spectrum beta-lactamase (ESBL)-producing EnterobacteriaceaeAgedAged, 80 and overAnti-Bacterial AgentsBacteriaBacterial InfectionsCarbapenemsFemaleHumansMaleMiddle AgedPropensity ScoreProspective StudiesTreatment Outcomeresearch article31075508open access10.1016/j.ijid.2019.04.0341878-3511https://doi.org/10.1016/j.ijid.2019.04.034