Can't keep it SECRET: system evaluation of carbapenem restriction against empirical therapy. Issue 1 (2nd January 2023)

• Record Type: Journal Article
• Authors: Wells, Drew A; Johnson, Asia J; Lukas, Jack G; Hobbs, Diana A; Cleveland, Kerry O; Twilla, Jennifer D; Hobbs, Athena L V
• Is Part Of: JAC-antimicrobial resistance. Volume 5:Issue 1(2023)
• Publication Date: 2023-01-02
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; Drug resistance in microorganisms -- Periodicals; 616.9041
• DOI: 10.1093/jacamr/dlac137
• Languages: English
• ISSNs: 2632-1823

Abstract

Abstract: Objectives: 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. Methods: 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. Results: The total number of carbapenem orders decreased between study periods at the intervention hospital (246 versus 61, P < 0.01). At the non-intervention hospitals, orders decreased, although not significantly (333 versus 279, P = 0.58). Meropenem orders decreased by 66% compared with 12% for the intervention and the non-intervention hospitals, respectively ( P < 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 ( P < 0.001). Using a stratified analysis to account for available resources, the estimated annual cost saving was $225 968 for the system. Conclusions: 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.