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Long-Term Carbapenems Antimicrobial Stewardship Program.

José Francisco García-Rodríguez1, Belén Bardán-García2, Pedro Miguel Juiz-González3

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Summary
This summary is machine-generated.

Carbapenem stewardship programs significantly improved prescription adequacy and reduced hospital-acquired multidrug-resistant bloodstream infections. These programs demonstrate clinical and ecological benefits, including fewer inpatient days and candidemia cases.

Keywords:
antimicrobial stewardshipbloodstream infectionscandidemiacarbapenemshospital infectionsmultidrug-resistant

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Area of Science:

  • Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Pharmacy

Background:

  • Carbapenems are crucial for treating multidrug-resistant infections but overuse drives resistance.
  • Effective stewardship programs are needed to optimize carbapenem use and mitigate resistance.
  • Evaluating the impact of such programs is essential for public health.

Purpose of the Study:

  • To assess the clinical and antibiotic resistance impact of carbapenem stewardship programs.
  • To evaluate the adequacy of carbapenem prescriptions against local guidelines.
  • To analyze changes in antibiotic consumption and hospital-acquired multidrug-resistant infections.

Main Methods:

  • A descriptive, pre-post-intervention study was conducted from January 2012 to December 2019 in a 350-bed teaching hospital.
  • Prospective audit and feedback to prescribers occurred from January 2015 to December 2019.
  • Antibiotic consumption and hospital-acquired multidrug-resistant bloodstream infections were analyzed.

Main Results:

  • Carbapenem prescription adequacy increased from 49.7% to 80.9% (p < 0.001) between 2015 and 2019.
  • Intervention acceptance was linked to shorter antibiotic treatment duration and fewer inpatient days (p < 0.05).
  • Meropenem consumption decreased (RR 0.58), while cefepime and piperacillin-tazobactam increased (RR 2.0 and 1.17, respectively). Hospital-acquired multidrug-resistant bloodstream infections and candidemia rates declined (RR 0.62, p = 0.02).

Conclusions:

  • Carbapenem stewardship programs can achieve significant clinical and ecological benefits over five years.
  • These programs reduce inpatient days, hospital-acquired multidrug-resistant bloodstream infections, and candidemia.
  • Optimized carbapenem use is achievable despite increased consumption of other antibiotics.