Vol.69 No.1 January 2021
Impact of post-prescription review and feedback provision by the antimicrobial stewardship team focused on carbapenem stewardship
1)Department of Medicine, Division of Clinical Infection Diseases, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
2)Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University
3)Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
Abstract
Carbapenems have a broad spectrum of activity and are often used as empirical therapy in patients with life-threatening infections. When the causative bacterium and its susceptibility spectrum is identified, a de-escalation (DE) strategy, such as the use of a narrower spectrum antibiotic, is important for proper carbapenem use, that is, to prevent unnecessarily prolonged therapy and emergence of antimicrobial resistance. We attempted to determine whether post-prescription review and provision of feedback (PPRF) by an antimicrobial stewardship team (AST) could promote carbapenem antimicrobial stewardship. The strategy of AST intervention, launched in July 2017, consisted of PPRF. We evaluated the prescription trend, including the rate of switching to other antimicrobials within 7 days during the periods prior to the start of the AST intervention (July 2016 to June 2017; pre-AST intervention period) and after the start of the AST intervention (July 2017 to June 2018; post-AST intervention period). A total of 2,685 patients were prescribed carbapenem during the entire study period (pre- vs. post-AST intervention period: 1,335 vs. 1,350). Confirming the use with the prescribing physicians, either in person or by telephone contact, was the primary interventional strategy adopted by the AST (976/1,350), followed in frequency by recommendation for discontinuation or change to another antibiotic (720/1,350). The rate of switching to narrower spectrum beta-lactams was significantly higher in the post-AST intervention period (7.0% vs. 13.0%; P<0.001). Daily PPRF by the AST could enhance carbapenem antimicrobial stewardship through promotion of switching to narrow spectrum antimicrobials.
Key word
carbapenem, antimicrobial stewardship team, defined daily dose
Received
June 26, 2020
Accepted
October 19, 2020
Jpn. J. Chemother. 69 (1): 1-7, 2021
