title: Safety and effectiveness of improving carbapenem use via prospective review and feedback in a multidisciplinary antimicrobial stewardship programme.
abstract: BACKGROUND
  Antimicrobial stewardship programmes (ASP) can reduce antibiotic use but patient safety concerns exist. We evaluated the safety of prospective carbapenem review and feedback and its impact on carbapenem use and patient outcomes.
  
  
  METHODS
  After 3 months implementation of our ASP, we compared patients with and without acceptance of ASP recommendations on the use of carbapenems. Primary outcome was 30-day mortality. Secondary outcomes included duration of carbapenem use, length of hospitalisation, clinical response, microbiological clearance, 30-day readmission and mortality at discharge.
  
  
  RESULTS
  Of 226 recommendations for 183 patients, 59.3% was accepted. De-escalation, switching to oral antibiotics and antibiotic cessation comprised 72% of recommendations. Patients with acceptance of ASP recommendations had lower 30-day mortality and higher end-of-therapy clinical response despite shorter carbapenem duration (P <0.05). Predictors of 30-day mortality were Pitt bacteraemia score (adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI], 1.11 to 1.74; P = 0.004) and non-acceptance of ASP recommendations (aOR 2.84, 95% CI, 1.21 to 6.64; P = 0.016).
  
  
  CONCLUSIONS
  Our prospective carbapenem review and feedback mainly comprising of reducing carbapenem use is safe.
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Teng
authors.forename: Tat Ming
authors.initials: TM
authors.lastname: Ng
authors.forename: Michelle W
authors.initials: MW
authors.lastname: Tan
authors.forename: Sock Hoon
authors.initials: SH
authors.lastname: Tan
authors.forename: Mindy
authors.initials: M
authors.lastname: Tay
authors.forename: Shu Fang
authors.initials: SF
authors.lastname: Lim
authors.forename: Li Min
authors.initials: LM
authors.lastname: Ling
authors.forename: Brenda S
authors.initials: BS
authors.lastname: Ang
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
mesh_terms: D015780:Carbapenems / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards*; D005246:Feedback; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D061214:Patient Safety; D010593:Pharmaceutical Services; D016896:Treatment Outcome
chemical_list: D015780:Carbapenems