Program Schedule

194
Antimicrobial Stewardship Evaluation of Meropenem Use at a Large Academic Medical Center

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Meropenem IDSA Poster 2014_FINAL.pdf (338.4 kB)
  • Background: Judicious carbapenem use in hospitalized patients is an important goal of antimicrobial stewardship program (ASP). Use of meropenem (M), the formulary carbapenem at our University hospital, is restricted to the ASP, infectious diseases (ID), and critical care. We report an ASP initiative to assess M utilization and prescribing patterns after change of ASP ordering process due to implementation of new computerized order entry system (CPOE).

    Methods: M utilization was measured in days of therapy (DOT)/1000 patient (pt) days.  Microbiological data, clinical and treatment characteristics were evaluated retrospectively for all patients who received ≥1 dose of M during 2ndquarter (Q2) of 2013. A GN isolate was considered an MDRO if non-susceptible to ≥1 agent in ≥3 antimicrobial classes. 

    Results: In the Q2 of 2013 M use increased by mean of 62 DOT/1000 pt-days at intensive care units [ICU], p=0.18 and by 12 DOT/1000 pt-days  in non-ICU units, p=0.31.  Among 145 patients who received M during Q2 of 2013, 43 were in ICU at M start. Most common approval source was from ID attending (43%) followed by an approval from critical care (24%) and ASP team (21%). Positive cultures with GN organisms were present in 53% of patients, and 44% of these were MDRO. The most common site of positive culture was urine, followed by lungs and blood.  Median duration of M was 7 (range 1-37) days. In ICU, twice as many patients received >14 days of therapy vs. nonICU (15.9% vs. 8.5%, p=0.27). M was used as escalation of therapy in 76% of patients (only 3/59 were due to discordant initial therapy).  Escalation of therapy within ≤24h was twice as frequent in ICU vs. nonICU (35% vs. 19%, p=0.1). M was deescalated in 18% of patients. An additional 22% of patients could have been deescalated based on susceptibility results. In logistic regression, prior MDRO infection or colonization (within 90 days) was identified as a predictor of current MDRO infection (OR 4.12, 95% CI 1.13-15.05, p=0.032) after adjusting for age >65 yrs, presence of comorbidities, need for ICU admission, and vasoactive agents at M start.

    Conclusion: ASP recommendations based on our findings include: implementation of CPOE flag for patients with prior MDRO; report M monthly utilization trends to ICU and medicine teams; and collaborate on practice agreement for initiation of restricted antibiotics by ASP team.

    Yanina Dubrovskaya, PharmD1, Justin Siegfried, PharmD2, Marco R. Scipione, PharmD3, Donald Chen, MD4, Michael Phillips, MD4 and John Papadopoulos, PharmD1, (1)Department of Pharmacy, NYU Langone Medical Center, New York, NY, (2)Pharmacy, New York University Langone Medical Center, New York, NY, (3)Department of Pharmacy, New York University-Langone Medical Center, New York, NY, (4)Infection Prevention and Control, NYU Langone Medical Center, New York, NY

    Disclosures:

    Y. Dubrovskaya, None

    J. Siegfried, None

    M. R. Scipione, None

    D. Chen, None

    M. Phillips, None

    J. Papadopoulos, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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