Targeted de-escalation rounds may effectively and safely reduce meropenem use.
OBJECTIVE
Use of meropenem in our hospital has doubled in recent years. An audit in 2013 showed that although initiation of therapy with meropenem was generally appropriate, therapy was rarely subsequently reviewed and de-escalated where appropriate. Therefore, a structured stewardship initiative focussed on meropenem de-escalation was developed.


METHODS
A local guideline for review and de-escalation of meropenem was developed and approved by the Antimicrobial Stewardship Team. The guideline outlined clinical and microbiological criteria which when met should lead to recommendation for meropenem de-escalation. Implementation of the guideline was piloted for a period of 4 weeks by a consultant microbiologist and an antimicrobial pharmacist. Days of meropenem use and crude mortality in those in whom de-escalation was implemented were compared with those where de-escalation was not recommended or was recommended but not implemented.


RESULTS
Thirty-three patients were reviewed. Overall, a recommendation to de-escalate from meropenem to a specified alternative antibiotic was made for 18 (55 %) patients. This advice was followed for 12 (36 %) patients. The median days of meropenem use in patients where meropenem was de-escalated was 4.5 days (range 2-19) compared with 14 days (range 6-84) where de-escalation was not recommended or the recommendation was not implemented. There was no statistically significant difference in crude mortality between patients de-escalated from meropenem and those where meropenem was continued.


CONCLUSIONS
This pilot study suggests that targeted carbapenem de-escalation stewardship activity based on pre-determined criteria, while labour intensive, can effectively and safely reduce meropenem use in the acute hospital setting.
Department of Medical Microbiology, University Hospital Galway, Newcastle Rd, Galway, Ireland. Una.NiRiain@hse.ie.
U
U
Ni Riain
Pharmacy Department, University Hospital Galway, Galway, Ireland.
M
M
Tierney
Department of Infectious Diseases, University Hospital Galway, Galway, Ireland.
C
C
Doyle
Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland.
A
A
Vellinga
Department of Infectious Diseases, University Hospital Galway, Galway, Ireland.
C
C
Fleming
Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland.
M
M
Cormican
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D013845:Thienamycins / Q000009:adverse effects* / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem
Meropenem de-escalation; Reduction carbapenem use; Targeted stewardship
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