Korean J healthc assoc Infect Control Prev.  2023 Jun;28(1):85-91. 10.14192/kjicp.2023.28.1.85.

Intervention for the Reduction of Long-term Carbapenem Prescriptions

• Choi SJ
• Lee DE
• Song SJ
• Kang H
• Lee CM
• Kang CK
• Park WB
• Kim NJ
• Choi EH
• Oh Md
• Choe PG

• KMID: 2543138
• DOI: http://doi.org/10.14192/kjicp.2023.28.1.85

Abstract

Background
In this study, we implemented an active intervention for patients taking carbapenems for 14 days or more at a single tertiary hospital and evaluated the effect of the intervention.
Methods
This was a quasi-experimental study comparing carbapenem use at 1-year preintervention to 1-year post-intervention. From January 2020, a pharmacist who participated in the Antibiotics Stewardship Program (ASP) monitored the weekly medical records of patients who were prescribed carbapenem for 14 days or more and notified the infectious disease specialist. The infectious disease specialist evaluated the appropriateness and recommended the termination of carbapenems via direct communication with the prescribing physician when carbapenems were inappropriately continued.
Results
Overall carbapenem consumption did not significantly differ after and before the intervention (43.0 vs. 43.5 daily defined doses (DDDs)/1,000 persons-day, P=0.630). In the interrupt time series analysis, the trend of carbapenem use did not differ before and during the intervention (P=0.732). In intervention periods, 367 patients who continued with carbapenems for more than two weeks were evaluated for appropriateness, and we intervened in 42 patients (11.4%). Carbapenem use was terminated in 40 patients (95.2%) within one week after the intervention via direct communication, whereas the remaining two patients developed infectious diseases requiring carbapenem administration within 30 days after the intervention.
Conclusion
In this study, there was no significant effect on the overall use of carbapenems since the intervention targeted only patients with long-term administration of carbapenems. However, inappropriate carbapenem use can be reduced through direct communication between infectious disease specialists and prescribing physicians, leading to high compliance reates and low infection recurrence.

Keyword

Antimicrobial stewardship program; Intervention; Carbapenem

Figure

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  Fig. 1 Trends of total (A) & each carbapenem ((B) Imipenem, (C) Meropenem, (D) Ertapenem) before and after intervention for long-term carbapenem prescription. Trends of carbapenem use before and after intervention for long-term carbapenem prescription. Monthly defined daily dose of carbapenem per 1,000 patients-day from 2019 to 2020. P1 is the P-value for immediate changes after intervention and P2 is the P-value for trends between pre- and post-intervention.

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