Methods: A before-after study was conducted from April, 2012 through March, 2015 at Tokyo Metropolitan Tama General Medical Center, a 790-bed, tertiary care medical center in Tokyo, Japan. Infectious disease consultation (intervention1) was initiated in July, 2013 and an once-weekly prospective audits and feedback on carbapenem antimicrobial use (intervention2) were conducted from April, 2014. Carbapenem use in patients with febrile neutropenia or those with infections susceptible only to carbapenem antimicrobials was considered to be appropriate. Cases considered to be inappropriate for carbapenem use were investigated by a pharmacist, and feedback including recommendations for its discontinuation or replacement with other agents was given to primary care providers. An interrupted time series analysis was performed to assess the impact of the infectious disease consultation and prospective audit on carbapenem use.
Results: After implementation of the infectious disease consultation and carbapenem audit, monthly carbapenem use decreased from 17.4 days of therapy (DOT) per 1,000 patient-days in the pre-intervention period to 8.36 DOT per 1,000 patient-days in the subsequent post-intervention periods (proportional reduction 0.48; 95% confidence interval 0.46 to 0.50) with no change in in-hospital mortality. The time series modeling revealed an immediate decrease in carbapenem use due to infectious disease consultation (P=0.01 for intercept), but not due to carbapenem audit and feedback (P=0.98 for intercept and P=0.15 for trend).
Conclusion: A multifaceted intervention including infectious disease consultation and carbapenem audit appear to be safe and effective in reducing overall carbapenem use.
Y. Tagashira, None
M. Higuchi, None
H. Honda, None