Abstract
Antimicrobial stewardship programs (ASP) promote appropriate antimicrobial use. We present a 4-year retrospective study that evaluated the clinical impact of the acceptance of the recommendations made by a meropenem-focused ASP. A total of 318 meropenem audits were performed. The ASP team (comprising infectious disease physicians, pharmacists and microbiologists) considered meropenem use in 96 audits (30.2%) to be inappropriate. The reasons to consider these uses inappropriate were the possibility of de-escalating to a narrower-spectrum antibiotic, in 66 (68.7%) audits, and unnecessary meropenem use, in 30 (31.3%) audits. The ASP team recommended de-escalation in 66 audits (68.7%) and discontinuation of meropenem in 30 audits (31.3%). ASP interventions were stratified according to whether or not recommendations were followed. The group in which recommendations were accepted and followed (i.e., accepted audit, AA) included 66 audits (68.7%) and the group in which recommendations were not followed (i.e., rejected audit, RA) included 30 (31.3%) audits. The comorbidity of the AA group (Charlson score) was higher than in the RA group (7.0 (5.0–9.0) vs. 6.0 (4.0–7.0), p = 0.02). Discontinuation of meropenem was recommended in 83.3% of audits in the AA group vs. 62.2% in the RA group (OR 3.05 (1.03–8.99), p = 0.04). Ertapenem de-escalation resulted in a 100% greater rate of follow-up compared with the non-carbapenem option (100% vs. 51.9%, OR 1.50 (1.21–1.860), p = 0.001). Significant differences were observed in the AA group when cultures were taken before antibiotic prescription—98.5% vs. 83.3% (p = 0.01, OR 13.0 (1.45–116.86))—or when screening cultures were taken—45.5% vs. 19.2% (p = 0.03, OR 3.5 (1.06–11.52)). There were no differences between the groups in terms of overall mortality and 30-day mortality, length of stay, Clostridiodes difficile infection, 30-day readmission or hospitalization costs. In conclusion, meropenem ASP recommendations contributed to a decrease in meropenem prescription without worsening clinical and economic outcomes.
Highlights
Antibiotics are one of the most common drugs prescribed in healthcare facilities [1]
The form most recommended by societies such as the Infectious Diseases Society of America is a prospective audit and feedback (PAF) process, in which a prescription is revised by a multidisciplinary team, which includes infectious disease (ID) specialists, clinical microbiologists and hospital pharmacists
Both groups had a high Charlson median score (6.0 (5.0–8.0)), but this was higher in the Accepted Audit (AA) group (7.0 (5.0–9.0) vs. 6.0 (4.0–7.0)), with a statistical difference found, p = 0.02
Summary
Antibiotics are one of the most common drugs prescribed in healthcare facilities [1]. Antibiotics are singular drugs, whose effect on bacterial ecology and misuse can directly impact microbial resistance [4], thereby increasing morbidity and hospital costs. It has been estimated that broad-spectrum antimicrobial misuse results in more than 23,000 deaths and $20 billion in costs every year in the United States [5,6]. Antimicrobial stewardship programs (ASPs) are ways to reduce the inappropriate use of antibiotics. The form most recommended by societies such as the Infectious Diseases Society of America is a prospective audit and feedback (PAF) process, in which a prescription is revised by a multidisciplinary team, which includes infectious disease (ID) specialists, clinical microbiologists and hospital pharmacists. The main goals of ASPs are to improve healthcare quality by optimizing antibiotic prescriptions, to reduce antimicrobial resistance and to conduct medical training on antibiotic use [7–9]
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