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Tractable targets for meropenem-sparing antimicrobial stewardship interventions
| Content Provider | Oxford Academic |
|---|---|
| Author | Russell, Clark D Laurenson, Ian F Evans, Morgan H Mackintosh, Claire L |
| Copyright Year | 2019 |
| Abstract | Background: As meropenem is a restricted antimicrobial, lessons learned from its real-life usage will be applicable to antimicrobial stewardship (AMS) more generally.ObjectivesTo retrospectively evaluate meropenem usage at our institution to identify targets for AMS interventions.MethodsPatients receiving meropenem documented with an 'alert antimicrobial' form at two tertiary care UK hospitals were identified retrospectively. Clinical records and microbiology results were reviewed.ResultsA total of 107 adult inpatients receiving meropenem were identified. This was first-line in 47% and escalation therapy in 53%. Source control was required in 28% of cases after escalation, for predictable reasons. Those ultimately requiring source control had received more prior antimicrobial agents than those who did not (P = 0.03). Meropenem was rationalized in 24% of cases (after median 4 days). Positive microbiology enabled rationalization (OR 12.3, 95% CI 2.7–55.5, P = 0.001) but rates of appropriate sampling varied. In cases with positive microbiology where meropenem was not rationalized, continuation was retrospectively considered clinically and microbiologically necessary in 8/40 cases (0/17 empirical first-line usage). Rationalization was more likely when meropenem susceptibility was not released on the microbiology report (OR 5.2, 95% CI 1.3–20.2, P = 0.02). Input from an infection specialist was associated with a reduced duration of meropenem therapy (P < 0.0001). Early review by an infection specialist has the potential to further facilitate rationalization.ConclusionsIn real-life clinical practice, core aspects of infection management remain tractable targets for AMS interventions: microbiological sampling, source control and infection specialist input. Further targets include supporting rationalization to less familiar carbapenem-sparing antimicrobials, restricting first-line meropenem usage and selectively reporting meropenem susceptibility. |
| Related Links | https://academic.oup.com/jacamr/article-pdf/1/2/dlz042/38268569/dlz042.pdf |
| File Format | |
| e-ISSN | 26321823 |
| DOI | 10.1093/jacamr/dlz042 |
| Journal | JAC-Antimicrobial Resistance |
| Issue Number | 2 |
| Volume Number | 1 |
| Language | English |
| Publisher | Oxford Academic |
| Publisher Date | 2019-09-01 |
| Access Restriction | Open |
| Subject Keyword | Biological Sciences Medical Microbiology and Virology Medicine and Health Microbiology Pathology Science and Mathematics Infections Meropenem Antimicrobials Antimicrobial Stewardship |
| Content Type | Text |
| Resource Type | Article |
| Subject | Microbiology (medical) Immunology and Allergy Microbiology Immunology Infectious Diseases |
