897. Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): A Quasi-Experimental Carbapenem Restriction Pilot at a Large Academic Medical Center. (15th December 2022)

• Record Type: Journal Article
• Authors: Wells, Drew; Johnson, Asia; Lukas, Jack; Mason, Darius; Cleveland, Kerry O; Bissell, Aaron; Hobbs, Athena L V
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.742
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Carbapenems' broad spectrum of activity may make these agents appealing for empiric use; however, their use is associated with development of Clostridioides difficile infection (CDI) and multi-drug resistance. Selective use of carbapenems is vital in maintaining their effectiveness. Our study aimed to examine the impact of meropenem restriction criteria on utilization and patient outcomes. Methods: This single-center, quasi-experimental study was conducted at an academic medical center where an initial medication use analysis found frequent inappropriate meropenem utilization. The antimicrobial stewardship team developed restriction criteria and implemented a pilot in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilization across 8 weeks in the pre-implementation period compared to the post-implementation period. The primary outcome was to compare the inappropriateness of meropenem utilization. Secondary outcomes included comparison of days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), frequency of CDI, and acquisition cost. Results: Across the 8 week timeframes, reductions in inappropriate meropenem use (64.5% vs 12.8%; p< 0.001), duration of therapy (5.8 [3.2-7.3] vs. 2.4 [1.0-5.5] days, p< 0.0001), and utilization (30.5 vs. 8.3 DOT/1000 PD, p=0.04) in the pre- and post-implementation periods, respectively, were observed. Total number of meropenem orders decreased by 65% (p< 0.001). Implementation of restriction criteria also resulted in decreased median hospital LOS between periods (11.9 [7.8-20.4] vs. 9.2 [5.4-15.2] days, p=0.05). There was no difference in frequency of CDI (2 vs. 0, p=0.99). Projected annual cost savings was approximately $57, 300. Conclusion: Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate utilization of meropenem, overall number of orders, and total duration of therapy. Disclosures: Kerry O. Cleveland, MD, AbbVie: Honoraria|Cumberland: Honoraria|Merck: Honoraria|Pfizer: Honoraria.