Retrospective assessment of antimicrobial stewardship initiative in outpatient use of ertapenem for uncomplicated extended spectrum beta lactamase Enterobacteriaceae urinary tract infections
| Autor: | Mariana Abraham, Thomas Delate, Julia K Nguyen, Su-Jau Yang, Carrie Wong, Elizabeth Hudson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Ertapenem medicine.medical_specialty Adolescent medicine.drug_class Urinary system medicine.medical_treatment Antibiotics Infectious and parasitic diseases RC109-216 Antimicrobial stewardship beta-Lactamases Cohort Studies chemistry.chemical_compound Medical microbiology Enterobacteriaceae Internal medicine Outpatients medicine Humans Adverse effect Retrospective Studies Urinary tract infection business.industry Research Enterobacteriaceae Infections Quality Improvement Anti-Bacterial Agents Infectious Diseases Aminoglycosides Treatment Outcome chemistry Urinary Tract Infections Beta-lactamase Female business Cohort study |
| Zdroj: | BMC Infectious Diseases BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-10 (2021) |
| ISSN: | 1471-2334 |
| Popis: | Background Urinary tract infections (UTI) are often over-diagnosed and over-treated, which can induce and select for resistant pathogens. After observing wide-spread outpatient use of ertapenem, a broad-spectrum antibiotic, a structured antimicrobial stewardship initiative (ASI) to improve appropriate antimicrobial prescribing was undertaken. ASI objectives were to achieve a goal of reducing ertapenem utilization for extended spectrum beta lactamase Enterobacteriaceae (ESBL-EB) UTI by 10% and evaluate the clinical outcomes associated with the ASI. Methods A pre-to-post cohort study was conducted at a single-center integrated healthcare system between November 1, 2014 and February 26, 2017. An intensive, 90-day, pharmacist-driven, structured ASI was implemented between November 1, 2015 and January 29, 2016. Female patients aged ≥18 years who were treated for an uncomplicated, ESBL-EB urinary tract infection (UTI) were included. Primary outcome was clinical resolution defined as cure, persistence, relapse and recurrence. Secondary outcome measured was monthly ertapenem use expressed as number of days of therapy (DOT)/1000 adjusted patient days (APD). Segmented regression analysis for interrupted time series was performed to estimate ASI intervention effect. Results A total of 184 patients were included in the study. Ertapenem utilization decreased from 0.0145 DOT/1000 APD in Nov. 2014 to 0.0078 DOT/1000 APD Feb. 2017(p p Conclusions A structured ASI for uncomplicated ESBL-EB UTI was associated with a clinically meaningful decrease in ertapenem utilization and once-daily, 5-day aminoglycoside treatment was well-tolerated. |
| Databáze: | OpenAIRE |
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