1625. A Multicenter Study to Optimize Carbapenem Use
Session: Poster Abstract Session: Stewardship: Targets for Intervention
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Multicenter Carbapenem ASherman.pdf (517.8 kB)
  • Background:

    Infection with carbapenem-resistant bacteria has become a major threat. Effective stewardship of antibiotics, particularly carbapenems, remains essential to control carbapenem-resistant bacteria. We attempted to determine the appropriateness of carbapenem use so that interventions to optimize carbapenem use can be specificly formulated.

    Methods:

    We developed criteria for appropriate, suboptimal, and inappropriate carbapenem use for empiric carbapenem use and non-empiric (after 48-72 hours with microbiology available culture results) carbapenem use. We conducted a multi-center, retrospective review across three of Emory-affiliated hospitals: the Atlanta Veterans Hospital (173 beds), Emory University Hospital (573 beds), and Emory University Midtown Hospital (511 beds). We reviewed 211 charts between July, 2015 and December 2015. The charts were randomly selected from patients >21 years old who were administered a carbapenem for more than 24h. We determined which carbapenem was used; patient location (ICU vs floor); any patient history of multi-drug resistant organisms; infection site; allergy history; and whether Infectious Disease consultation was obtained. One person (A.S.) reviewed all 211 charts for appropriateness of carbapenem use.

    Results:

    Of 211 cases, we classified 76% as appropriate use, 21% as suboptimal, and 3% as inappropriate. The most commonly identified reasons for suboptimal use were suspected severe intra-abdominal sepsis and limb or life-threatening soft tissue infections in which other, more narrow-spectrum formulary antibiotics were available for use. Four of six cases of inappropriate use occurred in the setting of beta-lactam allergy. For non-empiric carbapenem use, while we classified 69.7% (147/211) of use as appropriate, microbiology cultures were unrevealing in 19.9% (42/211) of cases. Cultures grew an organism necessitating carbapenem therapy in only 24% (51/211) of cases.

    Conclusion:

    Interventions to optimize carbapenem use should focus on clinical scenarios that commonly lead to suboptimal or inappropriate use. The frequency of unrevealing microbiology cultures suggests that more sensitive microbiologic techniques to determine causative agents may help to decrease carbapenem use.

    Amy Sherman, MD1, Federico Palaco, MD1, Tiffany Goolsby, PharmD2, Jesse Jacob, MD1, Jan Pack, PharmD3, Krysta Johnson-Martinez, MD4, Jordan Wong, PharmD5, Mary-Elizabeth. Sexton, MD1, Paula Frew, PhD, MA, MPH6, Scott Fridkin, MD1, Sheetal Kandiah, MD MPH7, Vincent Fenimore, PhD1 and Robert Gaynes, MD1, (1)Medicine, Emory University School of Medicine, Atlanta, GA, (2)Pharmacy, Atlanta Veterans Medical Center, Decatur, GA, (3)Pharmacy, Emory University Hospital, Atlanta, GA, (4)Medicine, Atlanta Veterans Medical Center, Decatur, GA, (5)Pharmacy, Grady Health System, Atlanta, GA, (6)Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (7)Medicine, Emory University, Decatur, GA

    Disclosures:

    A. Sherman, None

    F. Palaco, None

    T. Goolsby, None

    J. Jacob, None

    J. Pack, None

    K. Johnson-Martinez, None

    J. Wong, None

    M. E. Sexton, None

    P. Frew, None

    S. Fridkin, Pfizer: Consultant and Grant Investigator , Consulting fee and Research support

    S. Kandiah, None

    V. Fenimore, None

    R. Gaynes, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.