Carbapenems De-escalation as Antimicrobial Stewardship

A Cluster Randomized Controlled Trial Comparing Early and Late Carbapenems De-escalation in the Medicine Units, Maharaj Nakorn Chiang Mai Hospital

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03114358

Enrollment

104

Registered

2017-04-14

Start date

2016-06-01

Completion date

2017-02-28

Last updated

2017-04-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Anti-Bacterial Agents

Keywords

De-escalation, Carbapenems, Antimicrobial stewardship

Brief summary

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

Detailed 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.

Interventions

OTHEREarly Carbapenem de-escalation

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).

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

15 Years to No maximum

Healthy volunteers

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)

Design outcomes

Primary

Measure	Time frame	Description
The rate of de-escalation within the first 24 hour	24 hours	Compare the rate of de-escalation within the first 24 hour between arm 1 and arm 2

Secondary

Measure	Time frame	Description
Mortality rate	90 days	Compare the mortality rate between 2 groups
Readmission within 30 days,	30 days	Compare the rate of readmission within 30 days between 2 groups
Costs of carbapenems	30 days	Compare the cost of carbapenem prescription between 2 groups

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026