Impact of the multidisciplinary antimicrobial stewardship team intervention focusing on carbapenem de‐escalation: A single‐centre and interrupted time series analysis

Abstract

Background

As a result of the constant increase in carbapenem resistance amongst gram‐negative bacteria in several countries, the inappropriate use of carbapenems must be reduced. Antimicrobial stewardship programmes (ASPs) aim to improve carbapenem usage by implementing interventions, including the promotion of the de‐escalation (DE) strategy. Thus, this study aimed to evaluate the impact of this strategy on carbapenem use based on a clear definition of DE.

Methods

The post‐prescription review and feedback (PPRF) strategy, which is used to optimise carbapenem use, was implemented by the antimicrobial stewardship team (AST). We compared the DE rate during the pre‐AST intervention period (from April 2017 to March 2018) and post‐AST intervention period (from April 2018 to March 2019).

Result

A total of 1500 patients (n = 771 in the pre‐AST intervention period and n = 729 in the intervention post‐AST period) were admitted to the hospital. The average duration of antibiotic therapy decreased from 9.9 to 7.7 days. The DE rate significantly increased in the post‐AST intervention period compared with the pre‐AST intervention period (51.4% vs 40.3%; P < .001).

Conclusion

The PPRF strategy implemented by the AST could improve the carbapenem usage by increasing the DE rate of carbapenem.