Antimicrobial Stewardship Evaluation of Meropenem Use at a Large Academic Medical Center
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.
M. R. Scipione, None
D. Chen, None
M. Phillips, None
J. Papadopoulos, None