Category: Professional Posters
Purpose: Ertapenem was used throughout the organization for indications such as surgical prophylaxis, urinary tract infections, pneumonia, and sepsis. The antimicrobial stewardship team chose to focus on ensuring appropriate use of ertapenem due to its broad spectrum of activity and potential for emergence of resistance. A baseline medication use evaluation (MUE) for ertapenem identified opportunity for alternative therapy in roughly 75% of patients.
Methods: This was a single center, retrospective study comparing antibiotic utilization before (Oct 17-Aug 18) and after (Oct 18-Mar 19) implementation of an ertapenem restriction program. A baseline medication use evaluation (MUE) and review of current published treatment guidelines were utilized to develop criteria for ertapenem use. The MUE results were reported to the hospital’s stewardship team as well as the city-wide infectious disease group. The ertapenem restriction criteria was approved by the Pharmacy and Therapeutics Committee and included empiric therapy for patients with a history of infection or colonization with a multidrug-resistant organism, active infection with an extended-spectrum beta-lactamase producing organism, and a one-time dose prior to discharge for planned outpatient infusion therapy. Alternative therapies were provided for patients prescribed ertapenem for indications outside of the restriction criteria. Ertapenem culture and sensitivities were also removed from the antibiogram and suppressed on microbiology reports if the organism is susceptible to ceftriaxone. Prescriber education regarding the restriction criteria was conducted prior to the implementation. To determine the impact of the intervention, utilization was assessed before and after implementation for ertapenem, meropenem, and ceftriaxone. Utilization was assessed via days of therapy per 1000 patient days (DOT/1000 PD) and cost per patient day (cost/PD). Compliance with restriction criteria is monitored monthly with random audits.
Results: A decrease in mean DOT/1000 PD was experienced post-implementation of the ertapenem restriction criteria (8.8+2.4 vs. 20.2+3.7). Additionally, a reduction in mean cost/PD was observed ($0.66/PD vs. $1.87/PD) resulting in a $95,000 cost savings in the first six months of implementation. No difference was experienced in DOT/1000 PD of ceftriaxone (82.8+10.6 vs. 79.9+7.6) and a slight reduction in meropenem was observed (17.8+5.3 vs. 21.4+6.6). To date, all audited ertapenem orders have been compliant with the restriction criteria.
Conclusion: Implementation of an ertapenem restriction program was effective in decreasing utilization and expenditure without resulting an increase in ceftriaxone or meropenem.