Related Experiment Video
Updated: Aug 31, 2025
Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
Published on: April 18, 2019
Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): a quasi-experimental carbapenem restriction pilot at
Drew A Wells1, Asia J Johnson1, Jack G Lukas1
1Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA.
Abstract:
The broad-spectrum activity of carbapenems makes them appealing for empirical use; however, they are associated with development of Clostridioides difficile infection (CDI) and multidrug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We examined the impact of meropenem restriction criteria on utilisation and patient outcomes. This quasi-experimental study was conducted at a single academic medical centre after medication use evaluation found frequent inappropriate meropenem utilisation. Antimicrobial stewardship-led restriction criteria were developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilisation across 8 weeks in the pre- (February-April 2020) versus post-implementation period (February-April 2022). The primary outcome was inappropriateness of meropenem utilisation. Secondary outcomes included days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost. Across the 8-week timeframes, reductions in inappropriate meropenem use (64.5% vs. 12.8%; P < 0.001), duration of therapy [5.8 (3.2-7.3) vs. 2.4 (1.0-5.5) days; P < 0.001] and utilisation (30.5 vs. 8.3 DOT/1000 PD; P < 0.001) pre- versus post-implementation were observed. Total meropenem orders decreased by 65% (P < 0.001). Median hospital LOS also decreased between periods [11.9 (7.8-20.4) vs. 9.2 (5.4-15.2) days], although not statistically significant (P = 0.051). There was no difference in CDI SIR (0.1 vs. 0.1; P = 0.99). Projected annual cost savings were ∼US$57 300. Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate meropenem utilisation, overall number of orders, and total duration of therapy.
Insights
Implementing meropenem restriction criteria significantly reduced inappropriate use and duration of this carbapenem antibiotic. This antimicrobial stewardship strategy preserved effectiveness while decreasing costs.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Pharmacoeconomics
Background:
- Carbapenems are broad-spectrum antibiotics crucial for empirical therapy but linked to Clostridioides difficile infection (CDI) and resistance.
- Selective use of carbapenems is essential to maintain their clinical efficacy.
- Previous evaluations indicated frequent inappropriate meropenem utilization at an academic medical center.
Purpose of the Study:
- To assess the impact of antimicrobial stewardship-led meropenem restriction criteria on utilization and patient outcomes.
- To evaluate changes in inappropriate meropenem use, duration of therapy, and overall utilization.
- To determine the effect on hospital length of stay, CDI rates, and cost savings.
Main Methods:
- A quasi-experimental study comparing meropenem utilization and outcomes over 8-week periods before (2020) and after (2022) implementing restriction criteria.
- Data collected included inappropriate use rates, days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), and CDI Standardized Infection Ratio (SIR).
- Restriction criteria were developed and implemented by an antimicrobial stewardship team.
Main Results:
- Inappropriate meropenem use decreased from 64.5% to 12.8% (P < 0.001).
- Meropenem utilization (DOT/1000 PD) dropped from 30.5 to 8.3 (P < 0.001), with a 65% reduction in total orders (P < 0.001).
- Duration of therapy decreased significantly (5.8 to 2.4 days; P < 0.001), and projected annual cost savings were approximately $57,300.
Conclusions:
- Antimicrobial stewardship-initiated restriction criteria effectively reduce inappropriate meropenem utilization.
- Implementation of these criteria leads to decreased overall meropenem orders and duration of therapy.
- This strategy helps preserve the effectiveness of carbapenems and offers significant cost savings.
More Related Videos
08:58Cystic Fibrosis Aggregate Biofilm Model to Study Infection-relevant Gene Expression
Published on: April 18, 2025
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
