Carbapenem Reduction Strategy at a District General Hospital in England (UK)

Background Carbapenem antibiotics should be reserved for specialist use and to manage severe resistant Gram-negative infections, however injudicious use is linked to the selection of multi- and extensively-drug resistant organisms. Since 2016, Kettering General Hospital (KGH) has consistently been one of the biggest users of carbapenems (149.6 Define Daily Doses [DDDs]/1000 admissions, SD ± 22.1) compared to the average use in all England hospitals (mean 1.99 times more) and non-teaching hospitals (mean 2.48 times more). Here we report the results of an ongoing carbapenem reduction strategy.

Methods The AMS team developed a carbapenem reduction strategy in January 2021. The plan focused on optimising the carbapenem authorisation processes, reviewing sepsis guidelines and implementation, increasing use of antimicrobial guidelines, education and awareness, and continual review of patients on meropenem. Prescribing data (DDDs/1000 admissions including day case) were obtained through RxInfo Define and analysed in Microsoft Excel.

Results Over 2021-22, mean carbapenem use was reduced by 27.5% (to 108.9 ± 15.2 DDDs/1000 admissions) compared to the pre-pandemic baseline and reduced by 42.9% compared to the 2020-21 mean (190.8 ± 62.5 DDDs/1000 admissions) when pandemic surges inflated antimicrobial prescribing. This reduction was sustained at 92.7 DDDs/1000 admissions over 2022-23 with reduced month-on-month variation (SD ± 13.0).

Most actions completed were low-hanging-fruit within direct scope of the AMS team. Further reductions need to be delivered through engaging senior clinicians and managers across the organisation, improving carbapenem prescribing reports to clinicians, removing carbapenems from all guidelines, and improving AMS education to all staff groups.