ASSESSING THE APPROPRIATE USE OF MEROPENEM AND THE ASSOCIATION OF ACCEPTANCE OF ANTIMICROBIAL STEWARDSHIP (AMS) INTERVENTIONS WITH ADVERSE OUTCOMES IN A MALAYSIA TERTIARY HOSPITAL

Abstract

Intro: Carbapenems are the last effective defense against many multi-drug resistant organisms (MDRO) infections. AMS promotes judicious use of Meropenem to prevent MDRO emergence. This study assesses safety of AMS interventions and appropriateness of Meropenem prescriptions. Methods: Prospective study on Meropenem use conducted from January 2020 to December 2021 in University Malaya Medical Centre, a 1600-bed tertiary teaching hospital. Audit and feedback of usage by AMS team was conducted in all wards except for Haematology, Paediatrics and Intensive Care unit. The study period (P) had two phases; P1: January 2020 to September 2020 when AMS suggestions were written in patients’ electronic notes only, P2: October 2020 to December 2021 when AMS doctor would also discontinue Meropenem prescription if deemed unnecessary based on patients’ clinical progress. Safety of AMS interventions were assessed by comparing patients’ outcomes (mortality rates) in 2 groups: AMS interventions not accepted (AMS0) and AMS interventions accepted (AMS1). Interventions include Meropenem discontinuation, intravenous (IV) to oral conversion, narrowing empirical coverage, de-escalation based on cultures and sensitivities, duration. Causes of mortality (COM) in AMS1 group were analysed. Data collected using Redcap, an online platform, are analysed using SPSS 23. Findings: 852 and 1359 cases were audited during P1 and P2 respectively. 86.3% of Meropenem prescriptions were appropriate in P1 and 89.9% in P2. AMS interventions acceptance was 68.8% in P1 and 74.3% in P2. During P1, 30-day mortality rate was 17% (18/106) in AMS0 and 18.7% (42/225) in AMS1. During P2, 30-day mortality was 21.6% (24/111) in AMS0 and 21% (69/328) in AMS1. COM for AMS1 patients in P1 and P2 were non-infection related (i.e., malignancy) or due to infections not covered by Meropenem (i.e., fungus). Conclusion: Appropriateness of Meropenem prescriptions and acceptance of interventions improved from P1 to P2. Acceptance of interventions was shown to be safe.