Carbepenem Stewardship and the Impact on Appropriate Use and Clinical Outcomes

Abstract

Uncontrolled and excessive use of carbapenem is associated with a higher prevalence of carbapenem resistant Pseudomonas and Acinetobacter isolates. This contributes to poor clinical outcome, a higher rate of mortality and longer hospital stay compared with infections by susceptible isolates. To address the issue of carbapenem resistance, antibiotic monitoring is implemented to reduce consumption and improve appropriate prescribing of carbapenems. The aim of this study is to evaluate whether antibiotic stewardship will be able to improve appropriate carbapenem use and improve clinical outcomes in the local setting. This is a cross-sectional observational study that compares the use of carbapenem during pre-and intervention period. Interventions were carried out by a multidisciplinary antibiotic management team. A total of 143 patients treated with carbapenem were included in this study. A significantly higher rate of overall appropriate carbapenem treatment (pre n=26/79, 40.6% vs. intervention n=48/64, 60.8%, p=0.017) and clinical cure (pre n=34/79, 43% vs. intervention n=46/64, 72%, p=0.001] was identified during the intervention period. There were no significant difference in terms of mortality rate and length of hospitalization. This study suggests that carbapenem stewardship approach is effective in ensuring appropriateness of carbapenem treatment in a tertiary hospital.