Opportunities for antimicrobial stewardship among carbapenem-treated patients in 18 North American hospitals

Document Type

Article

Publication Date

4-10-2020

Publication Title

International journal of antimicrobial agents

Abstract

Here we describe the characteristics of carbapenem use at 18 hospitals across North America. Adult inpatients treated with a carbapenem for ≥24 h were included in this multicentre, retrospective, cross-sectional study. Outcomes evaluated included classification of therapy as empirical or definitive, discharge disposition and 30-day re-admission. A total of 621 patients were included in this study. Of these, 467 patients (75.2%) received a carbapenem empirically, among whom negative cultures occurred in 313 (67.0%) and 93% were eligible for de-escalation of therapy. In-hospital mortality occurred in 72 patients (11.6%) and 549 patients (88.4%) were discharged. Of the 549 patients who were discharged, 349 patients (63.6%) went home and 30-day infection-related re-admission occurred in 95 patients (17.3%). This population represents a significant need for carbapenem stewardship. Institutional guidelines should focus on four common disease states (respiratory, genitourinary, intra-abdominal and bloodstream), and diagnostic stewardship should be employed to aid in rapid de-escalation of carbapenem therapy. Additional studies aiming to identify antimicrobial stewardship techniques that may help to optimise carbapenem therapy and increase education about the importance of utilising carbapenem-sparing regimens are required.

Medical Subject Headings

Aged; Anti-Bacterial Agents/therapeutic use; Antimicrobial Stewardship; Carbapenems/therapeutic use; Cross-Sectional Studies; Drug Utilization/statistics & numerical data; Female; Gram-Negative Bacteria/drug effects; Gram-Negative Bacterial Infections/drug therapy; Hospitals; Humans; Impatiens; Male; Middle Aged; North America; Retrospective Studies; Treatment Outcome; Carbapenem; Gram-negative infection

PubMed ID

32283176

ePublication

ePub ahead of print

Volume

55

Issue

6

First Page

105970

Find It @ Sladen

Share

COinS