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Impact of an Antimicrobial Stewardship Initiative on Ertapenem Use and Carbapenem Susceptibilities at Four Community Hospitals

Delgado A, Gawrys GW, Duhon BM and Lee GC

Background: After observed widespread use of ertapenem at four community hospitals, antimicrobial stewardship initiatives (ASIs) were undertaken to minimize ertapenem use. Our objective was to evaluate the impact of ASIs on antibiotic utilization and Pseudomonas aeruginosa and Enterobacteriaceae susceptibility patterns.

Methods: This was a retrospective pre-post implementation study conducted at four Methodist Healthcare System hospitals in San Antonio, Texas from July 2013 to July 2015. A multilevel ASI to reduce ertapenem utilization was implemented in July 2014. The ASI comprised of a clinical decision support notification for prescribers, order set modification, formal provider education, and retrospective/prospective audit. Monthly ertapenem use was expressed in days of therapy (DOT)/1,000 adjusted patient days (APD). The rates of carbapenem nonsusceptible P. aeruginosa, Escherichia coli and Klebsiella pneumoniae were calculated monthly. A segmented regression analysis for interrupted time series was used to evaluate ertapenem usage pre- and post-intervention.

Results: Overall ertapenem utilization decreased across the study period (18.3 DOT/1,000 APDs in July 2013 vs. 5.1 in July 2015). The mean ertapenem DOT/1,000 APDs declined approximately 60% from the pre vs. post intervention period (17.6 vs. 7.0, p<0.001). Rates of group-2 carbapenem nonsusceptible P. aeruginosa isolates decreased in the post intervention period (4.9 per 10,000 APDs vs. 3.7 per 10,000 APDs; p=0.03), while carbapenem nonsusceptible E. coli and K. pneumoniae or remained stable across the study period.

Conclusion: This multilevel ASI aimed at minimizing ertapenem utilization resulted in substantial declined use. Susceptibilities of P. aeruginosa and Enterobacteriaceae isolates to group 2 carbapenems remained stable in the post-intervention period.