Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobial use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when deescalation or discontinuation of broad-spectrum antibiotics is recommended. Hence, we sought to evaluate...
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sg-ntu-dr.10356-872482020-11-01T05:17:06Z Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes Seah, Valerie Xue Fen Ong, Rina Yue Ling Lim, Ashley Shi Yuan Chong, Chia Yin Tan, Natalie Woon Hui Thoon, Koh Cheng Lee Kong Chian School of Medicine (LKCMedicine) Antimicrobial Stewardship Pediatric Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobial use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when deescalation or discontinuation of broad-spectrum antibiotics is recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers. We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes, including carbapenem utilization, length of stay, hospitalization charges, 30-day readmission, and mortality rates were reviewed. Data were analyzed in two groups, one in which physicians accepted all interventions (“accepted”) and one in which interventions were rejected (“rejected”). A total of 158 ASP interventions were made. These included carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging and procalcitonin) (11%), infectious diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%), and source control (1%). Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%) patients. A significant reduction in carbapenem utilization was observed in the accepted group versus rejected group (median defined daily doses, 0.224 versus 0.668 per 1,000 patient-days, respectively; P < 0.001). There was a significant reduction in 30-day mortality in the accepted (none) versus rejected group (10 deaths, P = 0.015), but there were no differences in length of stay, hospitalization charge, or 30-day readmission rates. Hypotension was independently associated with mortality in multivariate analysis (odds ratio, 5.25; 95% confidence interval, 1.34 to 20.6). In our institution, acceptance of carbapenem ASP interventions did not compromise patient safety in terms of clinical outcomes while reducing consumption. Published version 2018-02-01T04:28:29Z 2019-12-06T16:38:07Z 2018-02-01T04:28:29Z 2019-12-06T16:38:07Z 2017 Journal Article Seah, V. X. F., Ong, R. Y. L., Lim, A. S. Y., Chong, C. Y., Tan, N. W. H., & Thoon, K. C. (2017). Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes. Antimicrobial Agents and Chemotherapy, 61(9), e00736-17-. 0066-4804 https://hdl.handle.net/10356/87248 http://hdl.handle.net/10220/44363 10.1128/AAC.00736-17 en Antimicrobial Agents and Chemotherapy © 2017 American Society for Microbiology (ASM). This paper was published in Antimicrobial Agents and Chemotherapy and is made available as an electronic reprint (preprint) with permission of American Society for Microbiology (ASM). The published version is available at: [http://dx.doi.org/10.1128/AAC.00736-17]. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper is prohibited and is subject to penalties under law. 9 p. application/pdf |
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Antimicrobial Stewardship Pediatric Seah, Valerie Xue Fen Ong, Rina Yue Ling Lim, Ashley Shi Yuan Chong, Chia Yin Tan, Natalie Woon Hui Thoon, Koh Cheng Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
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Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobial use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when deescalation or discontinuation of broad-spectrum antibiotics is recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers. We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes, including carbapenem utilization, length of stay, hospitalization charges, 30-day readmission, and mortality rates were reviewed. Data were analyzed in two groups, one in which physicians accepted all interventions (“accepted”) and one in which interventions were rejected (“rejected”). A total of 158 ASP interventions were made. These included carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging and procalcitonin) (11%), infectious diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%), and source control (1%). Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%) patients. A significant reduction in carbapenem utilization was observed in the accepted group versus rejected group (median defined daily doses, 0.224 versus 0.668 per 1,000 patient-days, respectively; P < 0.001). There was a significant reduction in 30-day mortality in the accepted (none) versus rejected group (10 deaths, P = 0.015), but there were no differences in length of stay, hospitalization charge, or 30-day readmission rates. Hypotension was independently associated with mortality in multivariate analysis (odds ratio, 5.25; 95% confidence interval, 1.34 to 20.6). In our institution, acceptance of carbapenem ASP interventions did not compromise patient safety in terms of clinical outcomes while reducing consumption. |
author2 |
Lee Kong Chian School of Medicine (LKCMedicine) |
author_facet |
Lee Kong Chian School of Medicine (LKCMedicine) Seah, Valerie Xue Fen Ong, Rina Yue Ling Lim, Ashley Shi Yuan Chong, Chia Yin Tan, Natalie Woon Hui Thoon, Koh Cheng |
format |
Article |
author |
Seah, Valerie Xue Fen Ong, Rina Yue Ling Lim, Ashley Shi Yuan Chong, Chia Yin Tan, Natalie Woon Hui Thoon, Koh Cheng |
author_sort |
Seah, Valerie Xue Fen |
title |
Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
title_short |
Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
title_full |
Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
title_fullStr |
Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
title_full_unstemmed |
Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes |
title_sort |
impact of a carbapenem antimicrobial stewardship program on patient outcomes |
publishDate |
2018 |
url |
https://hdl.handle.net/10356/87248 http://hdl.handle.net/10220/44363 |
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1683493476251992064 |