Table 3.
Outcomes of patients in the de-escalation group (intervention) and in the non-de-escalation group (control)
| Outcomes | De-escalation (n = 32) | Non-de-escalation (n = 34) | P-value |
|---|---|---|---|
| Clinical outcomes | |||
| Clinical cure rate | 30 (93.8%) | 24 (79.4%) | 0.09 |
| Microbiological eradication ratea | 20/20 (100.0%) | 23/24 (95.8%) | 0.36 |
| 28-day mortality rate | 3 (9.4%) | 10 (29.4%) | 0.05b |
| • ID-related mortality | 1 (3.1%) | 9 (26.5%) | 0.01b |
| • Non ID-related mortality | 1 (3.1%) | 1 (2.9%) | 1.00b |
| Superimposed infection rate | 6 (18.8%) | 12 (35.3%) | 0.13 |
| • Acinetobacter baumannii | 2 (6.3%) | 6 (17.3%) | 0.26b |
| • MRSA | 2 (6.3%) | 3 (8.8%) | 1.00b |
| • Candida spp. | 1 (3.1%) | 4 (11.8%) | 0.51b |
| • Pseudomonas aeruginosa | 2 (6.3%) | 2 (5.9%) | 1.00b |
| • Enterococcus spp. | 2 (6.3%) | 0 | 0.23b |
| Cost-related outcomes | |||
| Median length of stay, days | 16.5 (4.0–73.0) | 20.0 (1.0–112.0) | 0.04b |
| Median length of stay after enrollment, days | 9.5 (0–37.0) | 11.5 (1.0–102.0) | 0.11b |
| Mean duration of carbapenem use, days | 14.4 ± 6.0 | 16.5 ± 10.5 | 0.32 |
| Mean DDD of carbapenem | 12.9 ± 8.9 | 18.4 ± 12.6 | 0.05 |
| Stool colonization | N = 32 | N = 32c | |
| At baseline | |||
| • Any MDR bacteria | 20 (62.5%) | 21 (65.6%) | 1.0 |
| • Any ESBL-producing GNB | 19 (59.4%) | 20 (62.5%) | 1.0 |
| • MDR-Acinetobacter baumannii | 4 (12.5%) | 3 (9.4%) | 1.0b |
| • MDR-Pseudomonas aeruginosa | 0 | 1 (3.1%) | 1.0b |
| At the end of therapy | |||
| • Any MDR bacteria | 16 (50.0%) | 11 (34.4%) | 0.31 |
| • Any ESBL-producing GNB | 11 (34.4%) | 8 (25.0%) | 0.59 |
| • MDR-Acinetobacter baumannii | 6 (18.8%) | 4 (12.5%) | 0.73b |
| • MDR-Pseudomonas aeruginosa | 1 (3.1%) | 0 (0.0%) | 1.0b |
aMicrobiological eradication was calculated in patients who had a follow-up culture of the infection site
bNonparametric test
cTwo patients in the group 2 carbapenem group had a contraindication for rectal swab culture
Abbreviations: MRSA methicillin-resistant Staphylococcus aureus, DDD defined daily dose, MDR multi-drug resistant, ESBL extended-spectrum beta-lactamase enzyme, GNB Gram-negative bacteria
Data are presented as n (%), mean ± SD or median (range); P-value < 0.05 indicates statistical significance