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IMPACT OF A CARBAPENEM ANTIMICROBIAL STEWARDSHIP PROGRAM ON PATIENT OUTCOMESABSTRACT
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes including carbapenem utilization, length-of-stay, hospitalization charges, 30-day readmission and mortality rates were reviewed. Data was analyzed in groups where physicians accepted all interventions (“Accepted”) versus rejected (“Rejected”).A total of 158 ASP interventions were made. These included: carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging, procalcitonin) (11%), Infectious Diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%) and source control (1%).Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%). Significant reduction in carbapenem utilization was observed in the “Accepted” group versus “Rejected” group (median defined daily doses: 0.224 versus 0.668 per 1000 patient-days, p |
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发表于 2017-10-20 08:50:00
发表于 2017-10-20 08:50:01
