Antimicrobial Stewardship Program for Patients in the Hematological Department Receiving Carbapenem Therapy: A Single-Center and Interrupted Time Series Analysis

Author:

Suzuki Ayako12ORCID,Yamaguchi Fumihiro23ORCID,Maeda Masayuki4ORCID,Hashiguchi Miyuki25,Kabasawa Nobuyuki26,Sasaki Jun27,Sato Tokutada28,Fuyama Masaki29,Yamazaki Yohei23,Endo Kei210,Iwata Kae211,Kobayashi Sei212,Fujihara Hisato113

Affiliation:

1. Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

2. Antimicrobial Stewardship Team, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

3. Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

4. Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo 142-8555, Japan

5. Department of Nursing, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

6. Department of Hematology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

7. Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

8. Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

9. Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

10. Department of Diabetes Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

11. Department of Inspection, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

12. Department of Otorhinolaryngology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan

13. Department of Hospital Pharmaceutics School of Pharmaceutical Sciences, Showa University, Tokyo 142-8666, Japan

Abstract

As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness of stewardship practices for immunocompromised patients remains uncertain. We determined the effect of AST interventions on carbapenem therapy in the department of hematology. Patients admitted to the department and undergoing carbapenem therapy were enrolled. We compared carbapenem use between the pre-AST (April 2016–March 2018) and post-AST (April 2018–March 2021) periods. Factors associated with long-term carbapenem therapy were investigated. Overall, 515 episodes of carbapenem therapy in 264 patients in the department were evaluated. According to the interrupted time series analysis, the number of days of therapy decreased with AST intervention (β = −0.263, p = 0.011). In multivariate analysis, predictive factors associated with long-term carbapenem therapy (>8 days) were outpatient onset, chronic obstructive pulmonary disease, acute myeloid leukemia, multiple myeloma, and infection with resistant bacteria (such as extended spectrum β-lactamases and AmpC) (95% confidence interval, 1.030–2.818, 1.067–66.667, 1.057–2.782, 0.168–0.742, and 1.382–5.750, respectively). The AST intervention reduced carbapenem use in patients with hematological disorders.

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology

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