Targeted de-escalation rounds may effectively and safely reduce meropenem use.

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Hospital Pharmacy

Background:

• Meropenem use has significantly increased, with audits revealing inappropriate prolonged use.
• Existing antimicrobial stewardship practices lacked specific protocols for meropenem de-escalation.
• A need for a structured approach to optimize meropenem therapy was identified.

Purpose of the Study:

• To develop and pilot a stewardship initiative focused on de-escalating meropenem therapy.
• To establish clear clinical and microbiological criteria for meropenem de-escalation.
• To evaluate the impact of this initiative on meropenem utilization and patient outcomes.

Main Methods:

• A local guideline for meropenem review and de-escalation was created and approved.
• The guideline was piloted over 4 weeks by a consultant microbiologist and antimicrobial pharmacist.
• Meropenem usage days and crude mortality were compared between de-escalated and non-de-escalated patient groups.

Main Results:

• Recommendations for meropenem de-escalation were made for 55% of reviewed patients.
• De-escalation was successfully implemented in 36% of patients.
• Median meropenem use decreased from 14 days to 4.5 days in de-escalated patients, with no significant difference in crude mortality.

Conclusions:

• Targeted carbapenem de-escalation stewardship, though resource-intensive, effectively reduces meropenem use.
• This approach is safe and can be implemented in acute hospital settings.
• The findings support the adoption of evidence-based criteria for antimicrobial de-escalation.