Background A carbapenem stewardship program was developed by a multidisciplinary team of specialists in Infectious Diseases, Critical Care, Pharmacy, Microbiology and Preventive Medicine. It expects to promote and improve the appropriate use of carbapenems.
Purpose To analyse the stewardship recommendations regarding the use of carbapenems.
Material and methods This prospective study lasted four months (May–August 2014) and was conducted in a tertiary hospital. The stewardship pharmacist selected patients who started carbapenem treatment, then a medical infections specialist recommended continuing or not with carbapenems, at the beginning and on the fifth and the tenth days of treatment, through oral and/or written communication with the prescriber. Resuscitation and paediatric patients were excluded. The variables analysed were: number and timing of interventions; type of recommendations and level of acceptance; cost (€) and defined daily dose (DDD) of carbapenems/100 stays of the period studied and compared with the same period last year; impact on other antimicrobials DDD/100 stays index.
Results A total of 210 recommendations were made, of which 69% were at the beginning, 22% on the fifth day and 9% on the tenth day. The recommendations were: antibiotic de-escalation (42%), continuation (38%), suspension of carbapenem (15%) and change of regimen (5%). 89.3% of the recommendations were accepted. Cost and DDD/100 stays of carbapenems were reduced by 63% and 58% over the same period in 2013. Regarding other antimicrobials, we must highlight the increase of DDD/100 stays for cloxacillin (74.6%) and piperacillin/tazobactam (27.4%) over the same period in 2013.
Conclusion The implementation of the carbapenem stewardship program has identified more than 60% of carbapenem prescriptions that could be improved. The high level of acceptance of recommendations has significantly reduced the use of carbapenems because many inappropriate treatments were suspended and the use of narrow-spectrum antimicrobials increased. In future analyses, the impact on the Hospital’s resistance profile should be considered.
References and/or Acknowledgements 1 SEFH
No conflict of interest.
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