Vol.74 No.4 July 2026
Impact of prolonged meropenem supply restriction on antimicrobial use in a small-scale cardiovascular specialty hospital
1)Department of Pharmacy, Hokkaido Cardiovascular Hospital, 1-30 Minami 27-jo, Nishi 13, Chuo-ku, Sapporo, Japan
2)Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital
3)Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science
Abstract
Following the nationwide supply restriction of meropenem (MEPM) in Japan in August 2022, Hokkaido Cardiovascular Hospital experienced a complete cessation of MEPM procurement for 18 months beginning in March 2023. Because MEPM is frequently prescribed for empirical treatment of severe infections, concerns arose regarding increased use of other broad-spectrum antibiotics and the potential negative impact on clinical outcomes. Our hospital is a small cardiovascular specialty hospital with 95 beds and does not have an antimicrobial stewardship team (AST). Given the facility characteristics, including a high proportion of elderly patients, a high prevalence of aspiration pneumonia, and a low prevalence of Pseudomonas aeruginosa, it was necessary to propose appropriate alternative antimicrobial therapies.
Based on these considerations, physicians and board-certified pharmacists discussed each case in advance to determine whether treatment without a carbapenem antibiotic would be feasible. As a result, sulbactam/ampicillin (SBT/ABPC) was frequently recommended as an alternative to MEPM. To evaluate this strategy, we retrospectively compared antimicrobial use, microbial susceptibility to antibiotics, and the clinical outcomes of patients who received SBT/ABPC as empirical therapy after MEPM supply interruption (Pre and Post-MEPM interruption groups, 18 months each).
The median days of therapy (DOT per 100 bed-days) for MEPM decreased from 0.9 in the Pre group to zero in the Post group, whereas that for SBT/ABPC increased from 1.7 in the Pre group to 3.2 in the Post group.
No significant changes were observed in the DOT for other antibiotics. In addition, there was no significant difference in the antimicrobial susceptibility pattern or adverse event incidence between the two periods. Although the 30-day mortality may have been influenced by various biases, it was lower in the Post group.
These findings suggest that, even in a small cardiovascular specialty hospital, continuous infectious disease management can be maintained during prolonged MEPM supply restriction through pharmacist-led recommendations of alternative antibiotics, primarily SBT/ABPC, without substantial deterioration of the clinical outcomes.
Key word
meropenem, carbapenem, sulbactam/ampicillin, days of therapy, empiric therapy
Received
February 4, 2026
Accepted
April 30, 2026
Jpn. J. Chemother. 74 (4): 482-491, 2026
