Widespread increase of empirical carbapenem use in acute care hospitals in Catalonia, Spain

Abstract

Introduction: The overall increase in the use of carbapenems could lead to the selection of carbapenem-resistant bacteria. The objectives of this study were to analyze carbapenem use from 2008 to 2015 and their prescription profile in 58 hospitals affiliated to the VINCat Programme (nosocomial infection vigilance system).

Methods: Retrospective, longitudinal and descriptive study of carbapenem use. Consecutive case-series study, looking for carbapenem prescription characteristics, conducted in January 2016. Use was calculated in defined daily doses (DDD)/100 patient-days (PD); prescription profiles were assessed using a standardized survey.

Results: Carbapenem use increased 88.43%, from 3.37 DDD/100-PD to 6.35 DDD/100-PD (p<0.001). A total of 631 patients were included in the prescription analysis. Carbapenems were prescribed empirically in 76.2% of patients, mainly for urinary tract and intra-abdominal infections due to suspicion of polymicrobial mixed infection (27.4%) and severity (25.4%).

Conclusion: A worrying increase in carbapenem use was found in Catalonia. Stewardship interventions are required to prevent carbapenem overuse.

Keywords: BLEE; Carbapenemas; Carbapenems; ESBL; Programas de optimización de uso de antimicrobianos (PROA); Programs for optimizing the use of antibiotics (PROA); Use of antimicrobials; Uso de antimicrobianos.