Infectious Disease Involvement Decreases Meropenem usage after Hematopoietic Stem Cell Transplantation
Background: Hematopoietic Stem Cell Transplant recipients (HSCT) are at increased risk for severe infections, and empiric antibiotic choice may be driven anecdotally by single patient experiences in addition to local antibiograms. Knowledge of recent infection patterns may be insufficient to adjust prescribing practices. We report the results of a synchronized collaborative effort between Infectious Diseases and HSCT attendings to decrease meropenem (MERO) use on an HSCT unit.
Methods: Antibiotics prescription practice on HSCT unit before, during and after interventions.
Results: MERO use peaked at 392 days of therapy (DOT) per 1000 pt-days in October 2011 and remained greater than 300 DOT per 1000 patient days through 2012. Twice yearly reporting of microbiology data directly to the HSCT team identified an increasing incidence of candidemia in 2012. Interventions included data sharing of recently recovered pathogens, recommendations use MERO then de-escalate to piperacillin-tazobactam (PTZ) with negative cultures, daily huddles between ID and HSCT to de-escalate antibiotics when indicated, and visual display of MERO prescribing patterns in the HSCT unit. Over the following 8 months, MERO use declined to 72 DOT per 1000 pt-days after which ID/HSCT huddles were decreased in frequency to twice weekly (FIG1). MERO use has remained stable over the ensuing 6 months, averaging 100 DOT per 1000 pt-days. PTZ use increased modestly from 203 DOT per 1000 pt-days in October 2011 to a mean of 227 DOT per 1000 pt-days during the last 6 months. Overall usage of the two antibiotics in the HSCT unit remains lower (peak of 619 in October 2011 to 307 DOT per 1000 pt-days currently, FIG2).
Conclusion: Multi-prong intervention including education, data sharing, concentrated antibiotic prescribing practices and improved communication resulted in decreased MERO use in the high-risk HSCT population.
D. Haslam, None
J. Courter, None
M. Cloughessy, None
B. Connelly, None