Background
Carbapenems are currently among the remaining few antibiotics to treat multidrug-resistant (MDR) bacteria, and their judicious use may contribute to the control of MDR.
Objectives
To evaluate the influence of facility-specific guidelines on optimal use of carbapenems, and to investigate their impact on patient outcomes in patients in a tertiary care hospital in Turkey where infectious diseases (ID) consultation and antibiotic approval are mandatory for carbapenem use.
Methods
This retrospective study was carried out in two time periods: the pre-guideline period (pre-GP) (2018) and the post-guideline period (post-GP) (2020). Primary outcome measure was appropriate use of carbapenems according to the predefined risk factor for MDR bacteria infections. Data on carbapenem treatment, antimicrobial consumption and infection density rate (IDR), and patient outcomes were extracted from the hospital information system.
Results
The appropriate use of carbapenems increased significantly after the implementation of hospital-specific guidelines (p < 0.001). This was also observed in the subset of patients with bloodstream infections (56.4% vs. 77.4%, p = 0.021). There was a trend for better treatment response in post-GP, albeit non-significant. Mortality rates were similar at Day 7, but higher at Day 30 in the post-GP (15.3%) compared to pre-GP (5.5%) (p < 0.001).
Conclusions
Appropriateness of carbapenem use increased with the introduction of local guidelines. Early mortality rates remained similar although more patients were in the ICU in the latter period. Implementation of a prospective carbapenem-focused stewardship strategy may further improve these results.