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

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Implementing meropenem restriction criteria significantly reduced carbapenem antibiotic use and spending across five hospitals. This antimicrobial stewardship strategy proved effective in optimizing meropenem utilization and controlling costs.

Keywords:
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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.