Keywords

1. Carbapenem Consumption Trends
2. Antimicrobial Stewardship
3. Hospital Antibiotic Usage
4. North American Carbapenem Use
5. Predictors of Carbapenem Consumption

The Rise and Implications of Carbapenem Consumption in North American Hospitals

In the realm of healthcare and infectious disease management, the use of antibiotics remains both a crucial lifesaving intervention and a consequential driver of antibiotic resistance. Among such antibiotics, carbapenems play a pivotal role due to their broad-spectrum activity against various bacteria, including those resistant to other antibiotics. A recent multicenter survey conducted by the MAD-ID Research Network has revealed significant insights into the trends and predictors of carbapenem consumption across North American hospitals. The study, published in the journal “Antimicrobial Agents and Chemotherapy,” presents data collected retrospectively from acute-care hospitals in the United States and Canada and offers a key perspective on the evolving landscape of antibiotic use.

Methodological Overview of the Study

Between January 2011 and December 2013, the multicenter survey analyzed carbapenem and broad-spectrum noncarbapenem beta-lactam consumption in 20 acute-care hospitals, treating adult patients. The results were calculated as defined daily doses (DDD) or days of therapy (DOT) per 1,000 patient days (PD), employing a multivariate mixed-effects model to identify factors influencing carbapenem use. This robust methodological approach ensured the accuracy and reliability of the study’s findings, providing a clear picture of carbapenem usage over the specified period.

Trends in Carbapenem Consumption

The data pointed to a mounting reliance on carbapenems, highlighting an urgent need for proactive antimicrobial stewardship. Notably, the study discovered that the consumption of these powerful antibiotics was not uniform across the surveyed institutions, varying notably between community, teaching, and university-affiliated hospitals. Such disparities in usage underscore the importance of tailored stewardship strategies that account for the unique context and patient population of each healthcare facility.

Predictors of Carbapenem Use

Through the application of a multivariate mixed-effects model, the researchers identified several factors that could predict carbapenem consumption. These predictors include hospital size, the presence of an antibiotic stewardship program, the incidence of certain antibiotic-resistant infections in the hospital, and the type of patient care units.

The Significance of Goodness of Fit Measures

Thoroughly assessing the goodness of fit through observed versus predicted values and residual distributions, the study ensured that the model used to predict antibiotic consumption was both appropriate and precise. It is these rigorous statistical validations that lend credence to the study’s conclusions and implications.

Implications for Antimicrobial Stewardship

The study’s findings call for reinforcement of antimicrobial stewardship programs, outlining their significance in moderating carbapenem use. Incorporating the revealed predictors into stewardship efforts could potentially curtail unnecessary carbapenem usage, thereby mitigating the emergence and spread of carbapenem-resistant organisms. With antibiotic resistance posing an ever-growing public health threat, as outlined in the CDC’s Antibiotic Resistance Threats report, targeted actions based on such research become increasingly critical.

The Economic and Clinical Impact of Increased Carbapenem Use

The potential economic burden of escalating carbapenem use cannot be understated. As highlighted by Bartsch et al., the financial implications of carbapenem-resistant Enterobacteriaceae (CRE) in the U.S. alone could be devastating. Furthermore, studies by Esterly et al. and Tumbarello et al. emphasize that the clinical outcomes of patients with bloodstream infections dramatically worsen with rising carbapenem minimum inhibitory concentrations (MICs), solidifying the necessity for judicious antibiotic use.

Conclusion and Recommendations

This detailed examination of carbapenem consumption trends and predictors across North American hospitals highlights the need for informed antimicrobial stewardship practices aligned with specific healthcare settings. The MAD-ID Research Network’s study serves as a wake-up call to healthcare professionals and policy makers to integrate evidence-based strategies to tackle the burgeoning problem of antibiotic resistance. Hospitals must heed these findings, reinforcing stewardship programs to ensure the continued effectiveness of carbapenem antibiotics in treating severe bacterial infections.

DOI and References

1. Rhodes, N. J., Wagner, J. L., Davis, S. L., Bosso, J. A., Goff, D. A., Rybak, M. J., & Scheetz, M. H. (2019). Trends in and Predictors of Carbapenem Consumption across North American Hospitals: Results from a Multicenter Survey by the MAD-ID Research Network. “Antimicrob Agents Chemother,” 63(7), e00327-19. DOI: 10.1128/AAC.00327-19

2. Antibiotic resistance threats in the United States, 2013. https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed January 2019.

3. Bartsch, S. M., McKinnell, J. A., Mueller, L. E., Miller, L. G., Gohil, S. K., Huang, S. S., & Lee, B. Y. (2017). Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. “Clin Microbiol Infect,” 23, 48.e9–48.e16. DOI: 10.1016/j.cmi.2016.09.003

4. Esterly, J. S., Wagner, J., McLaughlin, M. M., Postelnick, M. J., Qi, C., & Scheetz, M. H. (2012). Evaluation of clinical outcomes in patients with bloodstream infections due to Gram-negative bacteria according to carbapenem MIC stratification. “Antimicrob Agents Chemother,” 56(10), 4885–4890. DOI: 10.1128/AAC.06365-11

5. Tumbarello, M., Viale, P., Viscoli, C., Trecarichi, E. M., Tumietto, F., Marchese, A., … & Cauda, R. (2012). Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. “Clin Infect Dis,” 55(7), 943–950. DOI: 10.1093/cid/cis588

6. Yang, Y. S., Wang, Y. C., Kuo, S. C., Chen, C. T., Liu, C. P., Liu, Y. M., … & Lee, Y. T. (2017). Multicenter study of the relationship between carbapenem MIC values and clinical outcome of patients with acinetobacter bacteremia. “Antimicrob Agents Chemother.” DOI: 10.1128/AAC.00661-17

7. Patel, G., Huprikar, S., Factor, S. H., Jenkins, S. G., & Calfee, D. P. (2008). Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. “Infect Control Hosp Epidemiol,” 29(12), 1099–1106. DOI: 10.1086/592412