Preserving last resort antibiotics: A meropenem reduction strategy

Conlon‐Bingham, Geraldine; Hedderwick, S.; McKeating, Cara; McKee, Peter M.; McNally, Jessie C.; Lennon, Lisa M.; McGivern, Orla; Lewis, Kevin; McKenna, Dominic; Lattyak, Elizabeth A.; Lattyak, William J.; Aldeyab, Mamoon A.

doi:10.1017/ice.2021.276

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…In 14 of them, a meropenem recommendation was made, and in eight patients (60%), the recommendation was to discontinue its use. Similar results were shown by Conlon-Bingham et al [27] in a quasi-experimental study in which 75 patients treated with meropenem were reviewed. The ASP recommended discontinuation of meropenem in 47% of patients.…”

Section: Discussionsupporting

confidence: 85%

Impact of the Acceptance of the Recommendations Made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study

et al. 2022

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Antimicrobial stewardship programs (ASP) promote appropriate antimicrobial use. We present a 4-year retrospective study that evaluated the clinical impact of the acceptance of the recommendations made by a meropenem-focused ASP. A total of 318 meropenem audits were performed. The ASP team (comprising infectious disease physicians, pharmacists and microbiologists) considered meropenem use in 96 audits (30.2%) to be inappropriate. The reasons to consider these uses inappropriate were the possibility of de-escalating to a narrower-spectrum antibiotic, in 66 (68.7%) audits, and unnecessary meropenem use, in 30 (31.3%) audits. The ASP team recommended de-escalation in 66 audits (68.7%) and discontinuation of meropenem in 30 audits (31.3%). ASP interventions were stratified according to whether or not recommendations were followed. The group in which recommendations were accepted and followed (i.e., accepted audit, AA) included 66 audits (68.7%) and the group in which recommendations were not followed (i.e., rejected audit, RA) included 30 (31.3%) audits. The comorbidity of the AA group (Charlson score) was higher than in the RA group (7.0 (5.0–9.0) vs. 6.0 (4.0–7.0), p = 0.02). Discontinuation of meropenem was recommended in 83.3% of audits in the AA group vs. 62.2% in the RA group (OR 3.05 (1.03–8.99), p = 0.04). Ertapenem de-escalation resulted in a 100% greater rate of follow-up compared with the non-carbapenem option (100% vs. 51.9%, OR 1.50 (1.21–1.860), p = 0.001). Significant differences were observed in the AA group when cultures were taken before antibiotic prescription—98.5% vs. 83.3% (p = 0.01, OR 13.0 (1.45–116.86))—or when screening cultures were taken—45.5% vs. 19.2% (p = 0.03, OR 3.5 (1.06–11.52)). There were no differences between the groups in terms of overall mortality and 30-day mortality, length of stay, Clostridiodes difficile infection, 30-day readmission or hospitalization costs. In conclusion, meropenem ASP recommendations contributed to a decrease in meropenem prescription without worsening clinical and economic outcomes.

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Section: Discussionsupporting

confidence: 85%

Impact of the Acceptance of the Recommendations Made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study

et al. 2022

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“…52 Other studies showed the feasibility of implementing effective AMS interventions during the COVID-19 pandemic in healthcare settings. 53,54 Our data showed an upward trend in the hospital-based use of coamoxiclav (amoxicillin/clavulanic acid) during all waves of the COVID-19 pandemic. Similar findings were observed in a previous study.…”

Section: Discussionmentioning

confidence: 77%

“…Of note, AMS was shown to be effective in reducing antibiotic consumption in both hospital and nonhospital settings in a recent systematic review and meta‐analysis 52 . Other studies showed the feasibility of implementing effective AMS interventions during the COVID‐19 pandemic in healthcare settings 53,54 …”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

Aldeyab

Crowe

Karasneh

et al. 2023

Brit J Clinical Pharma

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AimTo evaluate the impact of the COVID‐19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland.MethodsData were collected on antibiotic use and Gram‐positive and Gram‐negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015‐March 2020) and during (April 2020‐December 2021) the pandemic. Time series intervention analysis methods were utilized.ResultsIn the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied‐bed days (OBD), showing no significant change from pre‐pandemic (P = .7365). During the pandemic, the use of second‐generation cephalosporins, third‐generation cephalosporins, co‐amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin‐susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID‐19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID‐19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community‐onset Pseudomonas aeruginosa cases.ConclusionThis study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID‐19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

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Primed for Discovery

Walker,

Clardy

2024

Biochemistry

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Antibiotics are essential components of current medical practice, but their effectiveness is being eroded by the increasing emergence of antimicrobial-resistant infections. At the same time, the rate of antibiotic discovery has slowed, and our future ability to treat infections is threatened. Among Christopher T. Walsh's many contributions to science was his early recognition of this threat and the potential of biosynthesis�genes and mechanisms�to contribute solutions. Here, we revisit a 2006 review by Walsh and co-workers that highlighted a major challenge in antibiotic natural product discovery: the daunting odds for identifying new naturally occurring antibiotics. The review described strategies to mitigate the odds challenge. These strategies have been used extensively by the natural product discovery community in the years since and have resulted in some promising discoveries. Despite these advances, the rarity of novel antibiotic natural products remains a barrier to discovery. We compare the challenge of discovering natural product antibiotics to the process of identifying new prime numbers, which are also challenging to find and an essential, if underappreciated, element of modern life. We propose that inclusion of filters for functional compounds early in the discovery pipeline is key to natural product antibiotic discovery, review some recent advances that enable this, and discuss some remaining challenges that need to be addressed to make antibiotic discovery sustainable in the future.

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Preserving last resort antibiotics: A meropenem reduction strategy

Cited by 3 publications

References 9 publications

Impact of the Acceptance of the Recommendations Made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study

Impact of the Acceptance of the Recommendations Made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

Primed for Discovery

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