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. 2014 Jun 9;9(6):e99101.
doi: 10.1371/journal.pone.0099101. eCollection 2014.

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  1 , Kyung Sook Yang  2 , Seung Eun Lee  3 , Hyun Jeong Kim  3 , Jang Wook Sohn  1 , Min Ja Kim  1
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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

Young Kyung Yoon et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: 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.

Figures

Figure 1
Figure 1. Trends of carbapenem-resistant Acinetobacter baumannii isolates (%) and carbapenem use (AUD, defined daily dose per 1,000 patient-days) during the study period.
See this image and copyright information in PMC

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This study was financially supported by Merck Sharp & Dohme. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.