Impact of an Antimicrobial Stewardship Protocol on Appropriateness of Meropenem Use in a Community Hospital
Year: 2016
Type: article
Study design: Clinical Trial
Abstract: Background. One of the main goals of antimicrobial stewardship programs (ASPs) is to promote appropriateness of antimicrobial utilization. Implementing ASPs in a community hospital can be challenging and with limited resources, programs to focus on appropriate use of broad spectrum agents such as carbapenems are desirable. Methods. This IRB-approved pre-/post-intervention study evaluated a multifaceted intervention to improve use of meropenem in a 300-bed community hospital. Criteria for appropriate indications for use and dosing of meropenem were developed by the ASP based on primary literature and professional recommendations. The intervention involved: (1) electronic health record (EHR) alert to prescribers of meropenem with a link to “appropriate use” guidelines (2) requirement of “indication for use” with meropenem orders in the EHR (3) development of dosing guidelines including an extended infusion option to optimize attainment of pharmacodynamic targets (4) pharmacist review of all meropenem orders for dose optimization (5) staff education for nurses, pharmacists and prescribers. Appropriateness of meropenem was assessed in 30 randomly selected adult inpatients prior to (January–Jun 2015) and after (September–December 2015) the intervention. Chi square tests were used to assess change in appropriateness of meropenem by indication and dosing as well as de-escalation. Hospital antimicrobial use data was evaluated using days of therapy (DOT) per 1000 patient days and length of therapy (LOT) per admission. Results. Thirty-eight courses of meropenem in 30 patients were assessed in the pre-intervention phase with 30 courses of meropenem in 30 patients in the post-intervention phase. Appropriateness of therapy based on indication increased from 60% (pre) to 93% (post), p = 0.004. Appropriateness of dose based on renal function increased from 66% (pre) to 93% (post), p = 0.03. De-escalation was performed more frequently after the intervention (63% pre, 83% post), p = 0.06. There was more than a 60% decline in meropenem DOT/1000 patient days and LOT/admission after the intervention period, which was sustained through March 2016. Conclusion. In a community hospital with limited resources, EHR and pharmacy resources can be harnessed to improve appropriateness of prescribing of broad spectrum antimicrobials such as meropenem. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Institutions: Duke University, Duke Medical Center
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2553703616