1504
Continue with order
Y
New order for carbapenem
Continuation of order from prior to admission?
N
History of ESBL or multi-drug resistant organism and/or culture positive for
organism resistant to all other available beta- lactam antibiotics?
Continue with order
YY N
Patient is severely ill (septic) and has failed to improve despite 48-72 hours of other broad spectrum antibiotics?
N
Carbapenem does not meet criteria for appropriate use. Recommend alternative empiric antimicrobial(s) or refer to culture & susceptibility report for alternative treatment of
targeted organism. Fig. 1. Carbapenem Prescribing Algorithm
Continue with order
Stacy E. Shimata et al
carbapenem resistance and susceptibility trends. Additionally, cost savings was calculated from antibiotic purchasing data, so these results may underestimate true cost savings. During our study period, there were several antibiotic drug shortages, so a larger supply of alternative antibiotics, such as carbapenems, may have been purchased in anticipation of a prolonged shortage. Strengths of this study include assessment of outcomes for an
extended duration, up to 1 year post-intervention, to evaluate the long- term effect of the implementation of the algorithm, which allowed study investigators to identify continued effects of the intervention. Due to a smaller physician and pharmacy personnel pool who were also amenable to the implementation of the algorithm, pharmacists were able to provide effective education on appropriate carbapenem prescribing that was sustained over time. This may also be a reason that these protocols are more successful in smaller institutions if buy-in is obtained before the protocol is implemented. Pharmacy-driven ASP strategies may be particularly effective
at both reducing antimicrobial utilization and improving anti- microbial susceptibility trends at small community hospitals.
Acknowledgments. We would like to acknowledge the STCH Antimicrobial Stewardship Committee and the Pharmacy Department for implementing the Carbapenem Prescribing Algorithm and the hospital physicians for supporting the success of our ASP.
Financial support. None reported. Conflicts of interest. All authors report no conflicts of interest to this article.
References
1. US Department of Health and Human Services. Antimicrobial resistance threats in the United States, 2013. Centers for Disease Control and Prevention website.
https://www.cdc.gov/drugresistance/threat-report- 2013/. Published 2013. Accessed June 12, 2018.
2. Livorsi DJ, Chorazy ML, Schweizer ML, et al. A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States. Antimicrob Resist Infect Control 2018;55:1–9.
3. Sader HS, Huband MD, Castanheira M, et al. Pseudomonas aeruginosa antimicrobial susceptibility results from four years (2012 to 2015) of the International Network for Optimal Resistance Monitoring Programin the United States. Antimicrob Agents Chemother 2017;61:1–7.
4. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.
5. Lai C, Shi Z, Chen Y, et al. Effects of various antimicrobial stewardship programs on antimicrobial usage and resistance among common gram- negative bacilli causing health-care associated infections: a multicenter comparison. J Microbiol Immunol Infect 2016;49:74–82.
6. Lew KY, Ng TM, Tan M, et al. Safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an ESBL-endemic setting. J Antimicrob Chemother 2015;70:1219–1225.
7. Ahmad F, Pogue JM, Marchaim D, et al. Evaluation of the potential impact of a carbapenem de-escalation program in an academic healthcare system. J Infect Public Health 2014;7:50–53.
8. Janssen J, Kinkade A, Man D. Carbapenem utilization evaluation in a large community hospital (CARBON): a quality improvement study. Can J Hosp Pharm 2015;68:327–331.
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