Department of Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, Florence, 50143, Italy.
University of Florence, Florence, Italy.
Eur J Intern Med. 2020 Aug;78:50-57. doi: 10.1016/j.ejim.2020.03.017. Epub 2020 Apr 14.
Carbapenem consumption is a major driver for selection and spread of carbapenem-resistant Enterobacterales (CRE). We assessed the impact of a carbapenem-focused multimodal antimicrobial stewardship program (ASP) in the internal medicine unit of a medium-size acute-care hospital.
We compared the percentage of inappropriate carbapenem prescriptions and the proportion of carbapenem treated patients registered in a 12-month pre-intervention and in a 24-month post-intervention period by using an interrupted time series analysis. The consumption of carbapenems, expressed in defined daily doses (DDD), was also assessed. As a secondary objective, the incidence of infections by carbapenem-resistant Klebsiella pneumoniae (CRKP) and the percentage of CRKP invasive isolates in the same time periods were compared.
After the ASP intervention, the mean monthly percentage of inappropriate carbapenem prescriptions dropped from 59% to 25%, and the mean monthly proportion of carbapenem treated patients decreased from 3% to 1%. The interrupted time series analysis confirmed a significant decrease in the percentage of inappropriate carbapenem prescriptions (-41.6%, p = 0.0262) and in the proportion of carbapenem treated patients (-2.1%, p < 0.0001). Carbapenem consumption decreased from 5.2 to 1.6 DDD x 100 patient-days. The incidence of CRKP infections remained unchanged (29.1 × 100,000 patient-days vs 28.9 × 100,000 patient-days, p = 0.9864) and the percentage of CRKP invasive isolates decreased, though not significantly, from 36.4% to 13.3% (p = 0.3478).
The implementation of a carbapenem-focused ASP was effective at limiting the inappropriate use of carbapenems and was associated with a significant decrease in carbapenem consumption. Such effects were sustained during a 24-month post-intervention period.
碳青霉烯类药物的使用是导致耐碳青霉烯类肠杆菌科（CRE）出现和传播的主要因素。我们评估了在一家中型急症护理医院的内科病房中实施以碳青霉烯类药物为重点的多模式抗菌药物管理计划（ASP）的效果。
我们使用中断时间序列分析比较了干预前 12 个月和干预后 24 个月期间，不适当碳青霉烯类药物处方的百分比和接受碳青霉烯类药物治疗的患者比例。还评估了碳青霉烯类药物的使用量，以限定日剂量（DDD）表示。作为次要目标，在相同时间段内比较了耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的发生率和 CRKP 侵袭性分离株的百分比。
在 ASP 干预后，每月不适当碳青霉烯类药物处方的平均百分比从 59%降至 25%，接受碳青霉烯类药物治疗的患者的平均比例从 3%降至 1%。中断时间序列分析证实，不适当碳青霉烯类药物处方的百分比（-41.6%，p=0.0262）和接受碳青霉烯类药物治疗的患者的比例（-2.1%，p<0.0001）均显著下降。碳青霉烯类药物的使用量从 5.2 至 1.6 DDD×100 患者日。CRKP 感染的发生率保持不变（29.1×100,000 患者日比 28.9×100,000 患者日，p=0.9864），CRKP 侵袭性分离株的百分比虽有所下降但无统计学意义，从 36.4%降至 13.3%（p=0.3478）。
实施以碳青霉烯类药物为重点的 ASP 可有效限制碳青霉烯类药物的不适当使用，并与碳青霉烯类药物使用量的显著下降相关。这种效果在干预后 24 个月的时间内持续存在。
