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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Acceptance and outcome of interventions in a meropenem de-escalation antimicrobial stewardship program in pediatrics

Kanokporn Rungsitsathian1,2, Noppadol Wacharachaisurapol2,3, Chotirat Nakaranurack4

  • 1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Pediatrics International : Official Journal of the Japan Pediatric Society
|March 19, 2021
PubMed

Insights

Antimicrobial stewardship programs (ASP) can effectively de-escalate meropenem therapy in children. Accepting ASP recommendations reduced carbapenem-resistant gram-negative bacteria acquisition, highlighting the importance of de-escalation strategies.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Pharmacy

Background:

  • Prospective audit and feedback by antimicrobial stewardship programs (ASP) facilitates tailored antibiotic therapy.
  • Evaluating the acceptance and outcomes of ASP de-escalation recommendations in pediatric meropenem use is crucial.

Purpose of the Study:

  • To assess the acceptance rate of ASP de-escalation recommendations for meropenem in children.
  • To evaluate the clinical outcomes and acquisition of carbapenem-resistant gram-negative bacteria (CR-GNB) following ASP de-escalation recommendations.

Main Methods:

  • A prospective cohort study involving children (1 month to 18 years) treated with meropenem.
  • ASP recommendations for de-escalation were provided 72-120 hours after meropenem initiation.
  • Outcomes included clinical success and CR-GNB acquisition rates within 30 days.

Main Results:

  • ASP recommended de-escalation in 41.5% of cases, with an overall acceptance rate of 57.8%.
  • Clinical success rates were comparable between accepted (85.2%) and rejected (77.5%) de-escalation recommendations (P=0.06).
  • Acquisition of CR-GNB was significantly lower in the accepted de-escalation group (5.8%) compared to the rejected group (15.8%) (P=0.03).

Conclusions:

  • Approximately half of ASP meropenem de-escalation recommendations were accepted in pediatric patients.
  • De-escalation of meropenem therapy was associated with a reduced incidence of CR-GNB acquisition.
  • Implementing a 72-hour post-carbapenem initiation de-escalation strategy is recommended to combat multidrug-resistant organisms.
Abstract

Keywords:
acceptanceantimicrobial stewardship program (asp)meropenempediatricsprospective audit and feedback

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