Highlights
- •CRE represent a major threat to public health.
- •Carbapenem overuse is a major driver for selection and spread of CRE.
- •ASPs can optimize carbapenem prescribing.
- •Our ASP resulted in over 40% reduction of inappropriate carbapenem use.
- •Carbapenem consumption substantially decreased after ASP implementation (-69.2%).
Abstract
Purpose
Carbapenem consumption is a major driver for selection and spread of carbapenem-resistant
Enterobacterales (CRE). We assessed the impact of a carbapenem-focused multimodal antimicrobial stewardship
program (ASP) in the internal medicine unit of a medium-size acute-care hospital.
Methods
We compared the percentage of inappropriate carbapenem prescriptions and the proportion
of carbapenem treated patients registered in a 12-month pre-intervention and in a
24-month post-intervention period by using an interrupted time series analysis. The
consumption of carbapenems, expressed in defined daily doses (DDD), was also assessed.
As a secondary objective, the incidence of infections by carbapenem-resistant Klebsiella pneumoniae (CRKP) and the percentage of CRKP invasive isolates in the same time periods were
compared.
Results
After the ASP intervention, the mean monthly percentage of inappropriate carbapenem
prescriptions dropped from 59% to 25%, and the mean monthly proportion of carbapenem
treated patients decreased from 3% to 1%. The interrupted time series analysis confirmed
a significant decrease in the percentage of inappropriate carbapenem prescriptions
(-41.6%, p = 0.0262) and in the proportion of carbapenem treated patients (-2.1%, p < 0.0001). Carbapenem consumption decreased from 5.2 to 1.6 DDD x 100 patient-days.
The incidence of CRKP infections remained unchanged (29.1 × 100,000 patient-days vs
28.9 × 100,000 patient-days, p = 0.9864) and the percentage of CRKP invasive isolates decreased, though not significantly,
from 36.4% to 13.3% (p = 0.3478).
Conclusions
The implementation of a carbapenem-focused ASP was effective at limiting the inappropriate
use of carbapenems and was associated with a significant decrease in carbapenem consumption.
Such effects were sustained during a 24-month post-intervention period.
Keywords
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Article info
Publication history
Published online: April 14, 2020
Accepted:
March 19,
2020
Received in revised form:
February 21,
2020
Received:
August 12,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
