Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program
Background: Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended i...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-04-01
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| Series: | Journal of Infection and Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034119303144 |
| _version_ | 1819227765064335360 |
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| author | Svetlana Sadyrbaeva-Dolgova Pilar Aznarte-Padial Alberto Jimenez-Morales Manuela Expósito-Ruiz Miguel Ángel Calleja-Hernández Carmen Hidalgo-Tenorio |
| author_facet | Svetlana Sadyrbaeva-Dolgova Pilar Aznarte-Padial Alberto Jimenez-Morales Manuela Expósito-Ruiz Miguel Ángel Calleja-Hernández Carmen Hidalgo-Tenorio |
| author_sort | Svetlana Sadyrbaeva-Dolgova |
| collection | DOAJ |
| description | Background: Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors. Methods: This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions. Results: De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p = 0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p < 0.001), although their exposure to carbapenems was lower (4 vs 6 days, p < 0.001).Factors associated with de-escalation were ICU stay for at least 48 h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality. Conclusions: Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate. Keywords: De-escalation, Carbapenems, Urinary tract infection, Antimicrobial stewardship programs, Pharmacist recommendations |
| first_indexed | 2024-12-23T10:46:35Z |
| format | Article |
| id | doaj.art-cd0d375e4b744049ac8ba84ecfe48a1a |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-12-23T10:46:35Z |
| publishDate | 2020-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-cd0d375e4b744049ac8ba84ecfe48a1a2022-12-21T17:50:00ZengElsevierJournal of Infection and Public Health1876-03412020-04-01134558563Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship programSvetlana Sadyrbaeva-Dolgova0Pilar Aznarte-Padial1Alberto Jimenez-Morales2Manuela Expósito-Ruiz3Miguel Ángel Calleja-Hernández4Carmen Hidalgo-Tenorio5Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain; Corresponding author at: Hospital Universitario Virgen de las Nieves, Av. Fuerzas Armadas, 2, 18014 Granada, Spain.Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, SpainDepartment of Pharmacy, University Hospital Virgen de las Nieves, Granada, SpainBio-health Research Institute (FIBAO), Granada, SpainDepartment of Pharmacy, University Hospital Virgen Macarena, Seville, SpainDepartment of Infectious Disease, University Hospital, SpainBackground: Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors. Methods: This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions. Results: De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p = 0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p < 0.001), although their exposure to carbapenems was lower (4 vs 6 days, p < 0.001).Factors associated with de-escalation were ICU stay for at least 48 h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality. Conclusions: Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate. Keywords: De-escalation, Carbapenems, Urinary tract infection, Antimicrobial stewardship programs, Pharmacist recommendationshttp://www.sciencedirect.com/science/article/pii/S1876034119303144 |
| spellingShingle | Svetlana Sadyrbaeva-Dolgova Pilar Aznarte-Padial Alberto Jimenez-Morales Manuela Expósito-Ruiz Miguel Ángel Calleja-Hernández Carmen Hidalgo-Tenorio Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program Journal of Infection and Public Health |
| title | Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program |
| title_full | Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program |
| title_fullStr | Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program |
| title_full_unstemmed | Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program |
| title_short | Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program |
| title_sort | pharmacist recommendations for carbapenem de escalation in urinary tract infection within an antimicrobial stewardship program |
| url | http://www.sciencedirect.com/science/article/pii/S1876034119303144 |
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