Journal article
A comprehensive assessment of carbapenem use across 90 Veterans Health Administration hospitals with defined stewardship strategies for carbapenems
Journal of antimicrobial chemotherapy, Vol.76(5), pp.1358-1365
04/13/2021
DOI: 10.1093/jac/dkab008
PMID: 33523128
Abstract
Carbapenems are an important target for antimicrobial stewardship (AS) efforts. In this study, we sought to compare different hospital-based strategies for improving carbapenem use.
We analysed a cohort of all patients hospitalized at Veterans Health Administration (VHA) acute care hospitals during 2016 and a mandatory survey that characterized each hospital's carbapenem-specific AS strategy into one of three types: no strategy (NS), prospective audit and feedback (PAF) or restrictive policies (RP). Carbapenem use was compared using risk-adjusted generalized estimating equations that accounted for clustering within hospitals. Two infectious disease (ID) physicians independently performed manual chart reviews in 425 randomly selected cases. Auditors assessed carbapenem appropriateness with an assessment score on Day 4 of therapy.
There were 429 062 admissions in 90 sites (24 NS, 8 PAF, 58 RP). Carbapenem use was lower at PAF than NS sites [rate ratio (RR) 0.6 (95% CI 0.4-0.9); P = 0.01] but similar between RP and NS sites. Carbapenem prescribing was considered appropriate/acceptable in 215 (50.6%) of the reviewed cases. Assessment scores were lower (i.e. better) at RP than NS sites (mean 2.3 versus 2.7; P < 0.01) but did not differ significantly between NS and PAF sites. ID consultations were more common at PAF/RP than NS sites (51% versus 29%; P < 0.01). ID consultations were associated with lower (i.e. better) assessment scores (mean 2.3 versus 2.6; P < 0.01).
In this VHA cohort, PAF strategies were associated with lower carbapenem use and ID consultation and RP strategies were associated with more appropriate carbapenem prescribing. AS and ID consultations may work complementarily and hospitals could leverage both to optimize carbapenem use.
Details
- Title: Subtitle
- A comprehensive assessment of carbapenem use across 90 Veterans Health Administration hospitals with defined stewardship strategies for carbapenems
- Creators
- Hiroyuki Suzuki - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAEli Perencevich - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAMichihiko Goto - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USABruce Alexander - Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USARajeshwari Nair - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAMireia Puig-Asensio - Hospital Universitari de Bellvitge, Barcelona, SpainErika Ernst - University of Iowa College of Pharmacy, Iowa City, IA, USADaniel J Livorsi - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Journal of antimicrobial chemotherapy, Vol.76(5), pp.1358-1365
- DOI
- 10.1093/jac/dkab008
- PMID
- 33523128
- NLM abbreviation
- J Antimicrob Chemother
- eISSN
- 1460-2091
- Publisher
- England
- Grant note
- name: Career Development Award; name: Veterans Affairs Health Services Research and Development Service, award: 16–204
- Language
- English
- Date published
- 04/13/2021
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984077782202771
Metrics
21 Record Views