Category: Professional Posters
Purpose: In 2013, the Centers for Disease Control reported carbapenem-resistant Enterobacteriaceae (CRE) as an urgent antibiotic resistance threat. Carbapenem utilization has been shown to significantly increase the risk of CRE. Implementing efforts to enhance appropriate utilization of meropenem is an important antimicrobial stewardship strategy. At the present study hospital, an initial medication use evaluation performed (MUE) in Dec 2017 (n=30) found only 3% of patients received meropenem for an appropriate indication. Investigators sought to assess the impact of a multidisciplinary approach on meropenem utilization.
Methods: This was a single center, retrospective study comparing meropenem utilization before (Jan-Dec 2017) and after (Jan-Dec 2018) implementation of a multidisciplinary intervention. The intervention included development of appropriate criteria for meropenem use, education to prescribers via various committees including antimicrobial stewardship, critical care, and Pharmacy and Therapeutics (Jan-Mar 2018), removal of meropenem from hospital guidelines and order sets (Jan 2018) and implementation of pharmacist prospective audit and intervention on meropenem orders not meeting criteria within 3 days (Apr 2018). Criteria for appropriate meropenem use included history of, or confirmed, ESBL infection, severe sepsis or septic shock in a febrile neutropenic patient, or empiric therapy for a positive Acinetobacter spp. culture. To assess the impact of the intervention, meropenem utilization (days of therapy per 1000 adjusted patient days, DOT/1000 AdjPD), annual expenditure, and antibiogram susceptibility were assessed pre- and post-implementation.
Results: Post-implementation, a reduction in meropenem DOT/1000 AdjPD (mean+SD, 4.5+16.4 vs. 21.3+4.2; p=0.0027) and annual expenditure ($5,650 vs. $16,952) was experienced. Pharmacists and providers successfully de-escalated meropenem in 50% (34/68) of eligible patients in the post-group. Additionally, meropenem susceptibility vs. Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae increased roughly 5% post-implementation.
Conclusion: Use of a multidisciplinary strategy focused on appropriate use, education, and modifications of current guidelines and order sets was effective in reducing meropenem utilization and enhancing appropriate use.