title: Evaluation of the potential impact of a carbapenem de-escalation program in an academic healthcare system.
abstract: The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum β-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patient-days (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution.
authors.affiliation: Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI, United States.
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmad
authors.affiliation: Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States. Electronic address: jpogue@dmc.org.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Detroit Medical Center, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Suchita
authors.initials: S
authors.lastname: Bheemreddy
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Jiha
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Detroit Medical Center, Detroit, MI, United States.
authors.forename: Niveditha S
authors.initials: NS
authors.lastname: Mudegowdra
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Aaisha
authors.initials: A
authors.lastname: Chaudhry
authors.affiliation: Division of Internal Medicine, Department of Infectious Diseases, Detroit Medical Center, Detroit, MI, United States; Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000046:Academic Medical Centers; D000150:Acinetobacter / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D006801:Humans; D008824:Michigan; D015233:Models, Statistical; D011549:Pseudomonas / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antimicrobial stewardship; Carbapenem; De-escalation; Ertapenem; Streamlining