Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study
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 (compri...
| Main Authors: | , , , , , , , |
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| Format: | info:eu-repo/semantics/article |
| Language: | eng |
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MDPI AG
2024
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10171/68408 |
| _version_ | 1793399910059474944 |
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| author | Alba-Fernández, J. (Jorge) Pozo, J.L. (José Luis) del Leiva, J. (José) Fernández-Alonso, M. (Miriam) Aquerreta, I. (Irene) Aldaz, A. (Azucena) Blanco, A. (Andrés) Yuste, J.R. (José Ramón) |
| author_facet | Alba-Fernández, J. (Jorge) Pozo, J.L. (José Luis) del Leiva, J. (José) Fernández-Alonso, M. (Miriam) Aquerreta, I. (Irene) Aldaz, A. (Azucena) Blanco, A. (Andrés) Yuste, J.R. (José Ramón) |
| author_sort | Alba-Fernández, J. (Jorge) |
| collection | DSpace |
| description | 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. |
| format | info:eu-repo/semantics/article |
| id | oai:dadun.unav.edu:10171-68408 |
| institution | Universidad de Navarra |
| language | eng |
| publishDate | 2024 |
| publisher | MDPI AG |
| record_format | dspace |
| spelling | oai:dadun.unav.edu:10171-684082024-02-05T13:33:53Z Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study Alba-Fernández, J. (Jorge) Pozo, J.L. (José Luis) del Leiva, J. (José) Fernández-Alonso, M. (Miriam) Aquerreta, I. (Irene) Aldaz, A. (Azucena) Blanco, A. (Andrés) Yuste, J.R. (José Ramón) Carbapenem Ertapenem Antimicrobial stewardships 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. 2024-01-17T12:59:09Z 2024-01-17T12:59:09Z 2022 info:eu-repo/semantics/article https://hdl.handle.net/10171/68408 eng info:eu-repo/semantics/openAccess application/pdf MDPI AG |
| spellingShingle | Carbapenem Ertapenem Antimicrobial stewardships Alba-Fernández, J. (Jorge) Pozo, J.L. (José Luis) del Leiva, J. (José) Fernández-Alonso, M. (Miriam) Aquerreta, I. (Irene) Aldaz, A. (Azucena) Blanco, A. (Andrés) Yuste, J.R. (José Ramón) Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title | Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title_full | Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title_fullStr | Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title_full_unstemmed | Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title_short | Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study |
| title_sort | impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: a pilot study |
| topic | Carbapenem Ertapenem Antimicrobial stewardships |
| url | https://hdl.handle.net/10171/68408 |
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