Prospective monitoring of carbapenem use and pseudomonal resistance across pediatric institutions

Abstract

Objective: To determine whether carbapenem consumption and Pseudomonas aeruginosa resistance rates can be used as benchmarks to compare and improve antimicrobial stewardship programs across multiple pediatric hospitals. Design: A prospective study. Setting and participants: Healthcare institutions in Japan with >100 pediatric beds. Methods: An annual survey of the total days of therapy (DOT) per 1,000 patient days for carbapenem antibiotics (meropenem, imipenem-cilastatin, panipenem-betamipron, doripenem) and susceptibility rates of Pseudomonas aeruginosa to meropenem and imipenem-cilastatin from each institution was conducted over a 7-year period. Data were reported to the administration, as well as to the infection control team, of each institution annually. Results: Data were obtained from 32 facilities. The median total carbapenem DOT per 1,000 patient days was 16.6 and varied widely, with a range of 2.7 to 59.0. The median susceptibility to meropenem was 86.6%, ranging from 78.6% to 96.6%. We detected an inverse correlation between total carbapenem DOT versus susceptibility (r = – 0.36; P < .01). Over the 7-year period, the DOT per 1,000 patient days of carbapenem decreased by 27% from a median of 16.0 to 11.7 (P < .01). We also observed an improvement in susceptibility to meropenem from a median of 87% to 89.7% (P = .01) and to imipenem-cilastatin from 79% to 85% (P < .01). The decreases in the use of carbapenem were greater in institutions with antimicrobial stewardship programs led by pediatric infectious disease specialists. Conclusions: Antimicrobial use and resistance, targeting carbapenems and P. aeruginosa, respectively, can serve as benchmarks that can be utilized to promote antimicrobial stewardship across pediatric healthcare institutions.

Acceptance and outcome of interventions in a meropenem de‐escalation antimicrobial stewardship program in pediatrics

“…In pediatric settings, an improvement in susceptibility to meropenem in P. aeruginosa was observed from a median of 87% to 89.7% over the 7 year period. 33 Our study did not report the drug susceptibility pattern in our setting, and further reports are needed about this. This study was the first prospective study of acceptance rate and clinical outcomes of meropenem de-escalation in pediatric patients in Thailand.…”

“…© 2021 Japan Pediatric Society Meropenem deescalation in pediatrics 1463 de-escalation, which resulted in the lower consumption of meropenem, can reduce the incidence of CR-GNB. There were studies in Japan 21,33 that reported the inverse correlation of carbapenem consumption and susceptibility of carbapenems in P. aeruginosa. In pediatric settings, an improvement in susceptibility to meropenem in P. aeruginosa was observed from a median of 87% to 89.7% over the 7 year period.…”

Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study

“…The spread of carbapenem-resistant Gram-negative bacteria (GNB) with the consequent change in institutional epidemiology continues to evolve rapidly worldwide [ 13 ]. Previous studies have showed that carbapenem resistance in GNB appeared to correlate with previous exposure to carbapenems [ 14 – 17 ] while reduction of carbapenem use, the incidence of Clostridioides difficile infection decreased [ 18 ]. Improper carbapenems use in targeted therapy for IPD should be reduced in China.…”

Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study

“…The spread of carbapenem-resistant Gramnegative bacteria (GNB) with the consequent change in institutional epidemiology continues to evolve rapidly worldwide [12]. Previous studies have showed that carbapenem resistance in GNB appeared to correlate with previous exposure to carbapenems [13,14,15,16]. And with reduction in carbapenem use, the incidence of Clostridioides di cile infection decreased [17].…”

“…Similarly, inappropriate antibiotics therapy group of meningitis also had higher proportion of patients with ICU admission, tracheal intubation and death (all P values 0.001), compared with appropriate antibiotics therapy group of meningitis (Table 5). 16.9% in the south, 12.5% in the northwest) and linezolid (11.1% in the north, 7.2% in the south, 1.9% in the east, 2.5% in the northwest) all differed by region (all P values 0.02) (Table 6). Inappropriate use rate of carbapenems and vancomycin was highest in the east.…”