The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli
Abstract Objective: This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes. Design: Quasi-experimental study. Setting: Tertiary care hospital in Turkey where infectious diseases (IDs) consu...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24004157/type/journal_article |
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| author | Cemre Boşnak Şeyda Betül Fındık Muhammed Atay Ward Fakhouri Sada Babazade Eda Karadoğan Gökhan Metan Ömrüm Uzun |
| author_facet | Cemre Boşnak Şeyda Betül Fındık Muhammed Atay Ward Fakhouri Sada Babazade Eda Karadoğan Gökhan Metan Ömrüm Uzun |
| author_sort | Cemre Boşnak |
| collection | DOAJ |
| description |
Abstract
Objective:
This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes.
Design:
Quasi-experimental study.
Setting:
Tertiary care hospital in Turkey where infectious diseases (IDs) consultation and antibiotic approval are mandatory for carbapenem use.
Participants:
All inpatients ≥18 years of age who received a carbapenem for at least 24 hours during the study periods were enrolled.
Intervention:
Hospital-specific treatment guidelines were introduced in April 2019. The control group was the year 2018, when there were no guidelines (pre-GP). The year 2020 was analyzed as the intervention period (post-GP).
Results:
A total of 678 patients were analyzed, 326 in the pre-GP period and 352 in the post-GP period. Following guideline implementation, there was a significant increase in appropriate carbapenem use (49.1% in pre-GP vs 71.9% in post-GP, P < .001). The duration of carbapenem use decreased significantly (P = .019). However, there was no significant change in the incidence of new infection episodes within the subsequent 30 days (27.6% in pre-GP vs 28.3% in post-GP), or in the length of hospitalization [median (25%–75%) = 28 (16–46) in pre-GP, 28 (15–47.5) in post-GP, P = .678]. Mortality rates were similar at day 7 post-GP (1.7%) compared to pre-GP (0.03%) (P = .125).
Conclusions:
The implementation of guidelines increased the appropriate utilization of carbapenems, without resulting in extended hospital stays or recurrent episodes. Despite an increased number of patients admitted to the ICU during the latter period, infection-related mortality rates remained comparable.
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| format | Article |
| id | doaj-art-d19a019c1358497d90eb6c5fdc867e9a |
| institution | OA Journals |
| issn | 2732-494X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-d19a019c1358497d90eb6c5fdc867e9a2025-08-20T01:55:11ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.415The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilliCemre Boşnak0https://orcid.org/0000-0002-6501-2614Şeyda Betül Fındık1https://orcid.org/0009-0009-1580-8866Muhammed Atay2https://orcid.org/0009-0004-4408-8427Ward Fakhouri3https://orcid.org/0009-0003-7217-7171Sada Babazade4https://orcid.org/0000-0002-4745-8671Eda Karadoğan5https://orcid.org/0000-0001-9972-5906Gökhan Metan6https://orcid.org/0000-0002-2676-4557Ömrüm Uzun7https://orcid.org/0000-0003-4721-0139Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, TurkeyFaculty of Medicine Graduate Program, Hacettepe University, Ankara, TurkeyFaculty of Medicine Graduate Program, Hacettepe University, Ankara, TurkeyFaculty of Medicine Graduate Program, Hacettepe University, Ankara, TurkeyFaculty of Medicine Graduate Program, Hacettepe University, Ankara, TurkeyFaculty of Medicine Department of Public Health Division of Epidemiology, Hacettepe University, Ankara, TurkeyDepartment of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, TurkeyDepartment of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, Turkey Abstract Objective: This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes. Design: Quasi-experimental study. Setting: Tertiary care hospital in Turkey where infectious diseases (IDs) consultation and antibiotic approval are mandatory for carbapenem use. Participants: All inpatients ≥18 years of age who received a carbapenem for at least 24 hours during the study periods were enrolled. Intervention: Hospital-specific treatment guidelines were introduced in April 2019. The control group was the year 2018, when there were no guidelines (pre-GP). The year 2020 was analyzed as the intervention period (post-GP). Results: A total of 678 patients were analyzed, 326 in the pre-GP period and 352 in the post-GP period. Following guideline implementation, there was a significant increase in appropriate carbapenem use (49.1% in pre-GP vs 71.9% in post-GP, P < .001). The duration of carbapenem use decreased significantly (P = .019). However, there was no significant change in the incidence of new infection episodes within the subsequent 30 days (27.6% in pre-GP vs 28.3% in post-GP), or in the length of hospitalization [median (25%–75%) = 28 (16–46) in pre-GP, 28 (15–47.5) in post-GP, P = .678]. Mortality rates were similar at day 7 post-GP (1.7%) compared to pre-GP (0.03%) (P = .125). Conclusions: The implementation of guidelines increased the appropriate utilization of carbapenems, without resulting in extended hospital stays or recurrent episodes. Despite an increased number of patients admitted to the ICU during the latter period, infection-related mortality rates remained comparable. https://www.cambridge.org/core/product/identifier/S2732494X24004157/type/journal_article |
| spellingShingle | Cemre Boşnak Şeyda Betül Fındık Muhammed Atay Ward Fakhouri Sada Babazade Eda Karadoğan Gökhan Metan Ömrüm Uzun The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli Antimicrobial Stewardship & Healthcare Epidemiology |
| title | The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli |
| title_full | The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli |
| title_fullStr | The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli |
| title_full_unstemmed | The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli |
| title_short | The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli |
| title_sort | impact of hospital specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug resistant gram negative bacilli |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24004157/type/journal_article |
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