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When using carbapenem antibiotics, decreased urine output should be reported immediately because it can be a sign of acute kidney injury or nephrotoxicity, which can occur due to various factors, including the medication itself. Carbapenems are known for their broad spectrum of antibacterial activity, but they can also affect renal function, especially in patients with pre-existing kidney issues or those who are dehydrated. Monitoring kidney function is crucial, as immediate intervention may be necessary to prevent further kidney damage.

In contrast, other symptoms like elevated blood pressure and increased appetite may not have an immediate relevance to the use of carbapenem antibiotics or may not indicate a serious adverse effect directly related to the treatment regimen. A rash, while it can signal an allergic reaction, may not always require immediate reporting unless accompanied by other severe symptoms, such as difficulty breathing or swelling, indicating a more severe allergic response. Therefore, decreased urine output stands out as the most critical parameter that necessitates prompt attention and action.