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In regions with a high prevalence of multidrug-resistant gram-negative bacteria, carbapenems are appropriate for empirical treatment of serious infections. Because use of such broad-spectrum antibiotics may have significant adverse effects for both the individual patient (e.g., risk for Clostridium difficile infection) and the community (e.g., further selection and expansion of carbapenemase-producing clones), following a de-escalation strategy —whenever possible — is advisable. Such strategies are reinforced by antibiotic stewardship committees in many institutions. But how do “de-escalated” patients fare compared with those who are continued on carbapenems?
A study conducted in Singapore, where extended-spectrum beta-lactamase–producing En…