An Evaluation of Meropenem Use and Resistance in a Mixed Medical/Surgical Intensive Care Unit. (4th October 2017)

• Record Type: Journal Article
• Authors: Crotty, Matthew; Reiter, Tamara; Hillebrand, Kristen; Tran, Tung; Dominguez, Edward
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S144
• Page End: S144
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.223
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Selective pressures applied to bacteria in the hospital provide a competitive advantage for nosocomial pathogens resistant to frequently utilized antimicrobials. Through this mechanism, non-fermenting Gram-negative bacilli (NFGNB) may become more prominent nosocomial pathogens where carbapenems are overused. Moreover, carbapenem use in hospitals and specific care units has been associated with increased rates of resistance among isolated pathogens. Better understanding of the relationship between the use of and resistance to meropenem (MEM) may promote judicious use of this last-line agent in the intensive care unit (ICU). Methods: Criteria for use with prospective audit and feedback was established for MEM at an urban community teaching hospital in September 2015. Antimicrobial utilization and susceptibility patterns of NFGNB from clinical cultures obtained from patients in a mixed medical-surgical ICU were collected from 1 January 2013 to 31 October 2016. Days-of-therapy per 1000 patient-days (DOT/1000PD) was utilized to describe the use of MEM. All clinical isolates of target organisms collected in the ICU were analyzed. Only the first isolate for a patient was included. MEM-resistant NFGNB rates were evaluated as number of isolates per/10, 000PD (MR-GNB/10, 000PD). January 2013 to August 2015 (pre-intervention) and September 2015 to October 2016 (post-intervention) groups were compared using Mann–Whitney U test for continuous variables and Fisher's exact or chi-square test for categorical variables. Results: The antimicrobial stewardship (AS) intervention led to decreased MEM utilization from 81 (pre-intervention) to 37 DOT/1000PD (post-intervention; P < 0.001). Additionally, fewer patients received at least one dose of MEM per month in the post-intervention group (19 vs. 14 median patients; P = 0.011). MR-GNB were isolated from clinic cultures less frequently following the intervention (15.4 vs. 3.7 MR-GNB/10, 000PD; P < 0.001). A reduction in Stenotrophomonas maltophila (10.2 vs. 3.1 isolates/10, 000PD; P = 0.014) was also observed after the intervention. Conclusion: Decreased MEM use following an AS intervention in a mixed ICU was associated with a reduction in MR-GNB. Further investigation of strategies to reduce the use of MEM is warranted. Disclosures: All authors: No reported disclosures.