Failure of educational interventions to reduce use of carbapenems in the intensive care unit of a tertiary care hospital

Nair, Sreejayan; Joseph, Noyal Mariya; Karnam, Ali Hassan; Rasitha, Desdemona; Kanungo, Reba

doi:10.1016/j.jhin.2016.05.007

Cited by 1 publication

(5 citation statements)

References 7 publications

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“…IDSA has not defined the optimal approach to prevent and contain antibiotic resistance . Despite recommendations for education as part of ASP, studies have shown it to be ineffective as a sole intervention . Shashikala et al aimed to decrease ICU carbapenem use with educational activities designed to increase clinicians understanding of appropriate indications .…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Shashikala et al aimed to decrease ICU carbapenem use with educational activities designed to increase clinicians understanding of appropriate indications. 11 They found no significant difference in daily-defined dose per 100 bed days between pre-and postintervention. A previous multicenter study implemented a respiratory fluoroquinolone restriction policy that educated providers on appropriate use, followed by a policy including pharmacist review of orders for consistency with approved restriction criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recommendations for education as part of ASP, studies have shown it to be ineffective as a sole intervention . Shashikala et al aimed to decrease ICU carbapenem use with educational activities designed to increase clinicians understanding of appropriate indications . They found no significant difference in daily‐defined dose per 100 bed days between pre‐ and postintervention.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, Infectious Diseases Society of America (IDSA) lists both as “strong recommendations” without providing further data on which is preferred . Solely drawing the physician's attention to inappropriate antimicrobial prescribing with education has not demonstrated a sustainable change in practice …”

Section: Introductionmentioning

confidence: 99%

“…10 Solely drawing the physician's attention to inappropriate antimicrobial prescribing with education has not demonstrated a sustainable change in practice. 11 The aim of this study was to assess the impact of a justification requirement on carbapenem use with an intervention that does not require substantial resources. A computerized antimicrobial approval system, called iApprove, was created to allow providers to prescribe restricted antibiotics for predetermined indications.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a multicenter stewardship‐targeted carbapenem justification requirement on the use of carbapenems in 23 hospitals

Johnk

Grindeland

Leedahl

et al. 2018

J Am Coll Clin Pharm

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Introduction Increasing resistance to broad‐spectrum antibiotics is a growing concern. Antimicrobial stewardship programs (ASPs) are needed to ensure appropriate antibiotic use, but the most effective method remains unknown. Objective To measure the change in carbapenem days of therapy (DOT) across 23 hospitals after a stewardship intervention and determine changes in morbidity, mortality, and resistance rates. Methods A retrospective, multicenter, sequential period analysis was initiated to evaluate carbapenem prescribing rates in 23 medical centers. We compared carbapenem utilization from December 1, 2016 to March 31, 2017 when a stewardship‐targeted justification was active with utilization from December 1, 2015 to March 31, 2016 without the justification requirement. Stewardship‐targeted justifications are appropriate indications for the prescribing of carbapenems selected by ASP leaders in our health care system. The primary outcome was carbapenem DOT per 1000 patient days (PDs). Results Carbapenem utilization decreased from 35.8 DOT per 1000 PDs in the preintervention period to 23.7 DOT per 1000 PDs in the postintervention period (33.8% reduction, P < .01). Morbidity and mortality end points were not adversely affected, with resistance rates remaining unchanged. Conclusions This study suggests that a stewardship‐targeted justification requirement in computerized physician order entry is an effective approach to reducing carbapenem utilization.

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Section: Discussionmentioning

confidence: 99%