Implementation of a prospective audit-and-feedback (PAF) intervention combined with an online tool was tied to an almost 10% reduction in carbapenem use at a Spanish hospital without worse patient outcomes, researchers reported today in the Journal of Antimicrobial Chemotherapy.
The study examined carbapenem use at a hospital in Barcelona 2 years before and 2 years after implementation of an online, real-time tool (the SAP business object, SAP-BO) that provides data on antibiotic consumption and helps antimicrobial stewardship programs (ASPs) assess and measure the success of a stewardship intervention. The study was conducted in the hospital's urology department, which was selected due to its high carbapenem usage, with the PAF specifically targeting carbapenem prescriptions. A total of 7,631 patients were included in the study, with 4,092 in the pre-intervention period and 3,359 in the intervention period.
There was a 9% decrease in carbapenem use as assessed by defined daily doses (DDD) per 100 patient-days (PD) in the intervention period (incidence ratio [IR], 0.91; 95% confidence interval [CI], 0.85 to 0.97). Carbapenem days of therapy (DOT)/100 PD also fell during the intervention period, decreasing from 12.4 to 11.0 (– 1.5 DOT/100 PD; IR, 089; 95% CI, 0.83 to 0.94). In addition, overall antibiotic DDD/100 PD fell by 3% (IR, 0.97; 95% CI, 0.94 to 0.99) and DOT/100 PD by 7% (IR, 0.93; 95% CI, 0.91 to 0.95).
Our study demonstrates the usefulness and safety of the implementation of an ASP that combines a [prospective audit-and-feedback] intervention with an electronic tool.
Analysis of the intervention's impact on patient safety found the incidence of infections caused by carbapenemase-producing organisms was similar in the two periods, as was the incidence of Enterococcus faecium bacteremia and Clostridioides difficile–associated diarrhea. The rate of extended-spectrum beta-lactamase incidence decreased, but the difference was not statistically significant. Length of hospital stay, in-hospital all-cause mortality, and 30-day readmission incidence remained unchanged.
"Overall, our study demonstrates the usefulness and safety of the implementation of an ASP that combines a PAF intervention with an electronic tool to reduce carbapenem use," the study authors wrote. "Further studies are needed to explore the ecological impact of similar programmes."