Using local clinical and microbiological data to develop an institution specific carbapenem-sparing strategy in...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Pharmacology

Background:

• Increasing prevalence of Gram-negative pathogens resistant to empiric sepsis therapy.
• Dilemma in escalating standard sepsis therapy to reserve antimicrobial agents.
• Need for localized antibiotic guidelines based on local epidemiology.

Purpose of the Study:

• Develop decision strategies for empiric sepsis therapy using local data.
• Estimate the number needed to treat (NNT) with carbapenem to avoid empiric therapy mismatch.
• Improve antibiotic stewardship by optimizing reserve agent use.

Main Methods:

• Nested case-control study of Gram-negative bacteremia (2013-2016).
• Defined cases as resistant to 2nd generation cephalosporin AND aminoglycoside.
• Analyzed demographic and clinical predictors of resistance.
• Estimated empiric therapy adequacy and NNT for different strategies.

Main Results:

• 486 episodes of Gram-negative bacteremia analyzed.
• 8.8% of episodes showed resistance to standard empiric therapy.
• Hematologic malignancy, prior resistant pathogens, and recent antibiotic use predicted resistance.
• Risk-based strategies achieved 95.2-99.3% empiric therapy adequacy.
• NNT for carbapenem reduced by 82.8% with targeted approaches.

Conclusions:

• Risk-based empiric sepsis therapy can target multi-resistant Gram-negative pathogens.
• Optimizing reserve antimicrobial agent use is crucial for stewardship.
• Structured evaluation of antimicrobial consumption and adequacy is essential for strategy selection.