Wells Drew A, Johnson Asia J, Lukas Jack G, Hobbs Diana A, Cleveland Kerry O, Twilla Jennifer D, Hobbs Athena L V
Department of Pharmacy, Methodist Le Bonheur Healthcare-University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA.
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, USA.
JAC Antimicrob Resist. 2023 Jan 2;5(1):dlac137. doi: 10.1093/jacamr/dlac137. eCollection 2023 Feb.
Carbapenems are appealing agents for empirical use given their broad spectrum of activity; however, selective use is vital in minimizing the risk for development of carbapenem-resistant pathogens. We aimed to examine the impact of carbapenem restriction criteria and a pre-authorization process on utilization and cost savings across a health system.
This retrospective study was conducted across five adult hospitals. The pre-implementation period was 8 February 2020 to 30 April 2020 and the post-implementation period was 8 February 2022 to 30 April 2022. The primary outcome was to compare the number of orders for carbapenems between the study periods for both the intervention and non-intervention hospitals. Secondary outcomes included projected annual cost and an estimated cost-savings evaluation using a stratified analysis for the intervention and non-intervention facilities to account for more resource-limited settings.
The total number of carbapenem orders decreased between study periods at the intervention hospital (246 versus 61, < 0.01). At the non-intervention hospitals, orders decreased, although not significantly (333 versus 279, = 0.58). Meropenem orders decreased by 66% compared with 12% for the intervention and the non-intervention hospitals, respectively ( < 0.001). Annual estimated cost for all facilities was $255 561 in the pre-implementation period compared with $29 593 in the post-implementation period ( < 0.001). Using a stratified analysis to account for available resources, the estimated annual cost saving was $225 968 for the system.
Implementation of carbapenem restriction at the intervention hospital decreased utilization and provided significant cost savings. Furthermore, resource-limited facilities can still experience significant cost savings using a stratified antimicrobial stewardship intervention approach.
碳青霉烯类药物因其广泛的抗菌活性而成为经验性用药的理想选择；然而，选择性使用对于将耐碳青霉烯类病原体的发生风险降至最低至关重要。我们旨在研究碳青霉烯类药物限制标准和预先授权程序对整个医疗系统药物使用和成本节约的影响。
这项回顾性研究在五家成人医院开展。实施前阶段为2020年2月8日至2020年4月30日，实施后阶段为2022年2月8日至2022年4月30日。主要结果是比较干预医院和非干预医院在研究期间碳青霉烯类药物的医嘱数量。次要结果包括预计年度成本以及使用分层分析对干预和非干预机构进行估计的成本节约评估，以考虑资源更为有限的情况。
干预医院在研究期间碳青霉烯类药物的医嘱总数有所下降（246例对61例，<0.01）。在非干预医院，医嘱数量也有所下降，尽管不显著（333例对279例，=0.58）。美罗培南的医嘱数量分别下降了66%和12%，干预医院与非干预医院相比差异有统计学意义（<0.001）。所有机构在实施前阶段的年度估计成本为255561美元，而在实施后阶段为29593美元（<0.001）。使用分层分析来考虑可用资源，该系统估计每年节约成本225968美元。
干预医院实施碳青霉烯类药物限制措施降低了药物使用量，并实现了显著的成本节约。此外，资源有限的机构采用分层抗菌药物管理干预方法仍可实现显著的成本节约。
