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Coordinated antibiotic management reduced carbapenem use
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SAN FRANCISCO — An antibiotic management team at Saint Joseph’s Hospital in Paris reduced the duration of carbapenems treatment in patients by controlling and auditing the daily prescription of the antibiotics, according to study results presented at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy.
“The routine control of carbapenem prescription by a team including an infectious disease specialist allowed us to reduce its use in hospitals and may be a strategy to control the emergence of carbapenemase-producing enterobacteriaceae in hospitals,” study researcher Carine Couzigou, MD, told Infectious Disease News.
Each prescription — including imipenem (Primaxin, Merck), ertapenem (Invanz, Merck), meropenem and doripenem (Doribax, Janssen) — was initiated by a physician and included written clinical justification and the expected duration of the regimen. An infectious diseases specialist, who performed the antibiotic controls each working day, could access the microbiological results of the antibiotic in real time and reassess the daily duration of the carbapenem treatment.
The effect of the monitoring was evaluated during a 6-month study period. The mean duration of carbapenem treatment (58 prescriptions) was calculated before and after each reassessment. Researchers used the Wilcoxon test to compare the duration of treatments.
Imipenem was prescribed 36 times (62%), ertapenem 15 times (26%) and meropenem seven times (12%). The primary indications for the antibiotics were urinary tract infections, intra-abdominal infections and pneumonia. Most patients (57%) were colonized or infected with extended spectrum beta-lactamase-producing enterobacteria. Results showed that in 34% of cases the infection was not microbiologically documented.
The antibiotic management team agreed to continue carbapenem treatment in 36 (62%) cases. When the team disagreed (38%), treatment was discontinued or switched to an antibiotic with a narrower spectrum, such as ceftriaxone, amoxicillin and clavulanic acid, piperacillin and tazobactam or ciprofloxacin.
According to the researchers, the average treatment duration planned by the initial physician using carbapenem was 11 days; after the assessment, the final duration was 7 days, much lower than what was initially planned (P<.05).
For more information:
Couzigou C. Presented at: 52nd ICAAC; Sept. 9-12, 2012; San Francisco.
Disclosure: Couzigou reported no relevant financial disclosures.