Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: A before and after intervention study of carbapenem-use stewardship

Young Kyung Yoon; Kyung Sook Yang; Seung Eun Lee; Hyun Jeong Kim; Jang Wook Sohn; Min Ja Kim

doi:10.1371/journal.pone.0099101

Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: A before and after intervention study of carbapenem-use stewardship

Young Kyung Yoon, Kyung Sook Yang, Seung Eun Lee, Hyun Jeong Kim, Jang Wook Sohn, Min Ja Kim

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

Abstract

Objective: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. Methods: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54). Results: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031). Conclusions: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

Original language	English
Article number	e99101
Journal	PloS one
Volume	9
Issue number	6
DOIs	https://doi.org/10.1371/journal.pone.0099101
Publication status	Published - 2014 Jun 9

Bibliographical note

Funding Information:
This study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The authors are in no way related with the employment, consultancy, patents, product development and marketing, etc., at Merck Sharp & Dohme. The opinions expressed in this paper are only those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Particularly, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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title = "Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: A before and after intervention study of carbapenem-use stewardship",

abstract = "Objective: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. Methods: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54). Results: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031). Conclusions: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.",

author = "Yoon, {Young Kyung} and Yang, {Kyung Sook} and Lee, {Seung Eun} and Kim, {Hyun Jeong} and Sohn, {Jang Wook} and Kim, {Min Ja}",

note = "Funding Information: This study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The authors are in no way related with the employment, consultancy, patents, product development and marketing, etc., at Merck Sharp & Dohme. The opinions expressed in this paper are only those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Particularly, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. ",

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AU - Yang, Kyung Sook

AU - Lee, Seung Eun

AU - Kim, Hyun Jeong

AU - Sohn, Jang Wook

AU - Kim, Min Ja

N1 - Funding Information: This study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The authors are in no way related with the employment, consultancy, patents, product development and marketing, etc., at Merck Sharp & Dohme. The opinions expressed in this paper are only those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. Particularly, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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Y1 - 2014/6/9

N2 - Objective: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. Methods: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54). Results: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031). Conclusions: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

AB - Objective: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. Methods: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54). Results: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001). The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031). Conclusions: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

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Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: A before and after intervention study of carbapenem-use stewardship

Abstract

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