Background : Ertapenem represents an attractive therapeutic option, with broad-spectrum coverage, daily administration, and a variety of FDA-approved indications. It is well known, however, that indiscriminate use of an antimicrobial agent evokes potential resistance. After observed widespread use of ertapenem at four community hospitals, antimicrobial stewardship initiatives (ASI) were undertaken to minimize its use. Our objective was to evaluate the impact of ASIs on antimicrobial use and Pseudomonas aeruginosa and Enterobacteriaceae susceptibilities.
Methods : This was a retrospective pre-post implementation study conducted in 4 Methodist Healthcare System hospitals in San Antonio, Texas from July 2013 to December 2014. A multilevel ASI to reduce ertapenem utilization was implemented in January 2014. The ASI comprised of a clinical decision support notification for prescribers, order set modification, formal provider education, retrospective/prospective audit, and administrative collaboration. Monthly ertapenem use was expressed in days of therapy (DOT). The rates of carbapenem nonsusceptible P. aeruginosa, Escherichia coli and Klebsiella pneumoniae per 1,000 isolates were calculated monthly. A t-test was used to evaluate ertapenem usage pre- and post-intervention. Linear regression was used to evaluate relationships of ertapenem use and rate of carbapenem-resistant isolates.
Results : Monthly ertapenem DOT decreased across the study period (841 DOT in July 2013 vs. 186 in December 2014). The mean ertapenem DOT declined approximately 50% from the pre vs. post intervention period (794 vs. 410, p < 0.001). Fluoroquinolone use decreased 15% (5838 vs. 4972), while group 2 carbapenem use did not significantly change across the study period. There were no significant trends in rates of carbapenem nonsusceptible P. aeruginosa isolates (r2=0.05) or carbapenem nonsusceptible E. coli and K. pneumoniae (r2=0.35) across the study period.
Conclusion : This multilevel ASI aimed at minimizing ertapenem utilization resulted in substantially declined use. Susceptibilities of P. aeruginosa and Enterobacteriaceae isolates to group 2 carbapenems remained stable in the post-intervention period.
G. W. Gawrys, None
B. M. Duhon, None
J. M. Koeller, None