Impact of a multicenter stewardship‐targeted carbapenem justification requirement on the use of carbapenems in 23 hospitals

Abstract

IntroductionIncreasing resistance to broad‐spectrum antibiotics is a growing concern. Antimicrobial stewardship programs (ASPs) are needed to ensure appropriate antibiotic use, but the most effective method remains unknown.ObjectiveTo measure the change in carbapenem days of therapy (DOT) across 23 hospitals after a stewardship intervention and determine changes in morbidity, mortality, and resistance rates.MethodsA retrospective, multicenter, sequential period analysis was initiated to evaluate carbapenem prescribing rates in 23 medical centers. We compared carbapenem utilization from December 1, 2016 to March 31, 2017 when a stewardship‐targeted justification was active with utilization from December 1, 2015 to March 31, 2016 without the justification requirement. Stewardship‐targeted justifications are appropriate indications for the prescribing of carbapenems selected by ASP leaders in our health care system. The primary outcome was carbapenem DOT per 1000 patient days (PDs).ResultsCarbapenem utilization decreased from 35.8 DOT per 1000 PDs in the preintervention period to 23.7 DOT per 1000 PDs in the postintervention period (33.8% reduction, P < .01). Morbidity and mortality end points were not adversely affected, with resistance rates remaining unchanged.ConclusionsThis study suggests that a stewardship‐targeted justification requirement in computerized physician order entry is an effective approach to reducing carbapenem utilization.