Restriction Evaluation of Appropriate Carbapenem Therapy (REACT): A Multisite Observational Study

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Health Services Research

Background:

• Carbapenem antibiotic overuse contributes to adverse patient effects and antimicrobial resistance.
• Effective antimicrobial stewardship programs are crucial for optimizing antibiotic use in healthcare settings.

Purpose of the Study:

• To evaluate the sustained impact of meropenem restriction criteria on utilization volume and appropriateness.
• To assess the effect of meropenem restriction on drug spending within a multi-hospital health system.

Main Methods:

• A retrospective observational study analyzed meropenem orders across 5 adult hospitals before and after restriction criteria implementation.
• Data on meropenem days of therapy/1000 patient days (DOT/1000 PDs) and drug spending were compared.
• Statistical analyses included t tests, Mann-Whitney U tests, chi-square, and Fisher's exact tests (P < 0.05).

Main Results:

• 39% of meropenem orders were inappropriate, with common reasons including penicillin allergy documentation and premature initiation.
• Median meropenem DOT/1000 PD decreased significantly from 40.5 to 20 (P < 0.001).
• Median monthly meropenem drug spend decreased by 42% across the health system (P = 0.001).

Conclusions:

• Meropenem restriction criteria effectively and sustainably reduce carbapenem use and associated healthcare costs.
• These criteria support the continued adoption of antimicrobial stewardship policies in multi-site health systems.
• The findings highlight the success of targeted interventions in optimizing antibiotic prescribing practices.