Available online 18 August 2022, 106661

Utilization of meropenem was evaluated in a 617-bed academic medical center.

Restriction criteria significantly decreased inappropriate meropenem utilization.

Length of stay, duration of meropenem use, and cost was significantly reduced.

Carbapenems’ broad spectrum of activity make these agents appealing for empiric use; however, their use is associated with development of Clostridioides difficile infection (CDI) and multi-drug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We aimed to examine the impact of meropenem restriction criteria on utilization and patient outcomes.

This quasi-experimental study was conducted at single academic medical center after a medication use evaluation found frequent inappropriate meropenem utilization. An antimicrobial stewardship- led restriction criteria was developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilization across 8 weeks in the pre- (2/8/2020-4/5/2020) vs. post-implementation period (2/8/2022-4/5/2022). The primary outcome was to compare inappropriateness of meropenem utilization. Secondary outcomes included days of therapy per 1000 days present (DOT/1000 DP), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost.

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<0.001), and utilization (30.5 vs. 8.3 DOT/1000 DP; p<0.001) in the pre- and post-implementation periods, respectively, were observed. Total meropenem orders decreased by 65% (p<0.001). Median hospital LOS also decreased between periods (11.9 [7.8-20.4] pre-implementation vs. 9.2 [5.4-15.2] days post-implementation), though it did not reach statistical significance (p=0.051). There was no difference in CDI SIR (0.1 vs. 0.1, p=0.99). Projected annual cost savings were ∼$57,300.

Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate utilization of meropenem, overall number of orders, and total duration of therapy.

Carbapenems

Restriction

Antimicrobial Stewardship

Extended-spectrum beta-lactamases

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