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. 2023 Feb 2;12(2):302.
doi: 10.3390/antibiotics12020302.

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

Ayako Suzuki  1   2 , Fumihiro Yamaguchi  2   3 , Masayuki Maeda  4 , Miyuki Hashiguchi  2   5 , Nobuyuki Kabasawa  2   6 , Jun Sasaki  2   7 , Tokutada Sato  2   8 , Masaki Fuyama  2   9 , Yohei Yamazaki  2   3 , Kei Endo  2   10 , Kae Iwata  2   11 , Sei Kobayashi  2   12 , Hisato Fujihara  1   13
Affiliations

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

Ayako Suzuki et al. Antibiotics (Basel). .

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.

Keywords: antimicrobial stewardship; carbapenem; hematological disorders; interrupted time series analysis; predictive factors.

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Conflict of interest statement

The authors declare no conflict of interest. The sponsors had no role in the design, execution, interpretation, or writing of the study.

Figures

Figure 1
Figure 1
Patient information. Many patients were repeatedly hospitalized. Among them, carbapenems were used multiple times, and we evaluated each use.
Figure 2
Figure 2
(a) Interrupted time series analysis of the trends in days of therapy (DOT) for carbapenem per 100 patient-days evaluated before and after the implementation of the antimicrobial stewardship team (AST). Solid lines indicate the observed trend in the pre- and postimplementation periods. After AST implementation, the trend in the monthly DOT decreased (β = −0.263, p = 0.011). (b) Interrupted time series analysis of the trends in carbapenem antimicrobial use density (AUD) per 100 patient-days evaluated before and after the implementation of the antimicrobial stewardship program. Solid lines indicate the observed trend in the pre- and postimplementation periods. After AST implementation, the trend in the monthly AUD decreased (β = −0.291, p = 0.003).
Figure 2
Figure 2
(a) Interrupted time series analysis of the trends in days of therapy (DOT) for carbapenem per 100 patient-days evaluated before and after the implementation of the antimicrobial stewardship team (AST). Solid lines indicate the observed trend in the pre- and postimplementation periods. After AST implementation, the trend in the monthly DOT decreased (β = −0.263, p = 0.011). (b) Interrupted time series analysis of the trends in carbapenem antimicrobial use density (AUD) per 100 patient-days evaluated before and after the implementation of the antimicrobial stewardship program. Solid lines indicate the observed trend in the pre- and postimplementation periods. After AST implementation, the trend in the monthly AUD decreased (β = −0.291, p = 0.003).
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