Carbapenem stewardship – positive impact on hospital ecology

Lima, Ana Lúcia Munhoz; Oliveira, Priscila Rosalba Domingos de; Paula, Adriana Pereira de; Dal-Paz, Karine; Almeida, João Nóbrega de; Félix, Cássia da Silva; Rossi, Flávia

doi:10.1016/s1413-8670(11)70131-3

Cited by 19 publications

(17 citation statements)

References 14 publications

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“…However, isolation rates of CRAB increased continuously during the implementation of the antibiotic-stewardship program. Similarly, a statistically significant reduction in CRAB rates was not observed previously following the implementation of a comprehensive antibiotic-stewardship program [15], [22], [26]. These findings suggest that the development of antibiotic resistance is multifactorial.…”

Section: Discussionmentioning

confidence: 46%

“…Factors that are predictive of CRAB acquisition have been reported to include old age, a deteriorated functional status, ICU stay, recent invasive procedures or surgeries, prolonged hospital stay, immunosuppression, and antibiotic exposure [9]. Of particular interest is that prior exposure to imipenem has been reported as the main risk factor for CRAB acquisition [20]–[22]. In vitro, imipenem might potently induce MDR A. baumannii strains [8].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Yoon¹,

Yang

Lee

2014

PLoS ONE

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ObjectiveAntimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems.MethodsA before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1–18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19–36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37–54).ResultsDuring the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031).ConclusionsImplementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Yoon¹,

Yang

Lee

2014

PLoS ONE

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“…In some cases, this type of restriction has been shown to result in improved Pseudomonal susceptibilities to these antimicrobials 26 , 27 . However, as mentioned previously, this type of restriction may lead to the “squeezing of the balloon” effect in which there is increased use of alternative agents such as piperacillin/tazobactam and cefepime for empiric broad-spectrum treatment and ertapenem for certain resistant Gram-negative organisms 7 .…”

Section: Discussionmentioning

confidence: 99%

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

et al. 2013

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In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come.

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“…Some authors report that, the use of Ertapenem may help to improve the Imipenem sensitivity of P. aeruginosa by reducing unnecessary use of the IMP and the reduction of selection pressure [23–27]. According to Livemore et al, the wise use and consistency with the recommendations of the marketing authorization does not cause high risk or an additional selection of mutant's resistants ( P. aeruginosa, A. baumannii) to Carbapenems including Imipenem [28].…”

Section: Discussionmentioning

confidence: 99%

In Vitro Activities of Ertapenem and Imipenem against Clinical Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Collected in Military Teaching Hospital Mohammed V of Rabat

Elouennass

Zohoun

Ameri

et al. 2012

Interdisciplinary Perspectives on Infectious Diseases

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Objective. To study the sensitivity level of extended spectrum beta-lactamase-producing Enterobacteriaceae to Carbapenems (Imipenem, Ertapenem) marketed in Morocco and discusses the place of Ertapenem in the treatment of extended spectrum-beta-lactamase-producing. Materials and Methods. A retrospective study of 110 extended spectrum beta-lactamase-producing Enterobacteriaceae. Isolates obtained from blood cultures, superficial and deep pus, and catheters were conducted. The minimum inhibitory concentrations of Imipenem and Ertapenem were done by the E-test. The modified Hodge test was conducted for resistant or intermediate strains. Results. 99.1% of isolates were susceptible to Imipenem. For Ertapenem, 4 were resistant and 4 intermediate. The modified Hodge test was positive for all 08 isolates. A minimum inhibitory concentration comparison of K. pneumoniae, E. cloacae, and E. coli for Imipenem has noted a significant difference between E. cloacae on one hand and E. coli, K. pneumoniae on the other hand (P < 0.01). No significant difference was noted for minimum inhibitory concentration of Ertapenem. Conclusion. Our results confirm in vitro effectiveness of Ertapenem against extended spectrum beta-lactamase-producing Enterobacteriaceae as reported elsewhere. However, the emergence of resistance to Carbapenems revealed by production of carbapenemases in this study confirmed a necessary bacteriological documented infection before using Ertapenem.

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Carbapenem stewardship – positive impact on hospital ecology

Abstract: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

Cited by 19 publications

References 14 publications

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Effects of Group 1 versus Group 2 Carbapenems on the Susceptibility of Acinetobacter baumannii to Carbapenems: A Before and After Intervention Study of Carbapenem-Use Stewardship

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

In Vitro Activities of Ertapenem and Imipenem against Clinical Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Collected in Military Teaching Hospital Mohammed V of Rabat

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