Clinical Outcomes and Factors Associated with Mortality after De-escalation in Carbapenem Antimicrobial Stewardship Program at Internal Medicine Ward

Abstract

Objective: To investigate 30-days mortality rate and factors associated with mortality in patients who received antimicrobial de-escalation in a carbapenem antimicrobial stewardship program, and to assess the acceptance rate of physicians regarding pharmacists’ recommendations. Methods: A retrospective cohort study collected data from patients with gram-negative bacterial infections who received at least one dose of carbapenems and underwent de-escalation based on antimicrobial susceptibility results. The patients were treated in the internal medicine wards of King Chulalongkorn Memorial Hospital, Thai Red Cross Society, under an antimicrobial stewardship program with pharmacist evaluation from January 1, 2022, to June 30, 2024. Results: This study analyzed data from 311 patients with a total of 379 prescriptions. The majority of the initial prescriptions were for empirical therapy (80.21%). Meropenem was the most frequently prescribed antibiotics (97.89%). Among patients who underwent antimicrobial de-escalation, the mortality rate was 19.61%. Factors significantly associated with mortality in these patients included septic shock (adjusted odds ratio (aOR)1.94, 95% confidence interval (CI)1.03-3.65) and being under mechanical ventilation support (aOR 2.15, 95%CI 1.14-4.06). Physicians accepted 86.30% of the recommendations made by pharmacists. Conclusion: Antimicrobial de-escalation for patients with gram-negative infections who received carbapenems by antimicrobial susceptibility is recommended, as it leads to low mortality and relapse rates within 30 days. Close monitoring is essential for patients with septic shock and mechanical ventilation support after de-escalation.