The Impact of Intensive Care Unit Stewardship on the appropriateness of Meropenem prescription at a tertiary hospital: A Quasi-Experimental Study

Background: Carbapenem-resistant Enterobacteriaceae (CRE) prevalence has shown increasing prevelance in Saudi Arabia, which poses a significant health concern. The antimicrobial stewardship program (ASP) plays an important role in reducing resistance by ensuring appropriate use of antibiotics.

Method: This is a retrospective data collection study performed over 3 years from 2020 to 2022, at a tertiary hospital which included adult patients who were hospitalized in the ICU and received Meropenem. The primary objective was to evaluate the appropriateness of meropenem prescription in the ICU pre-ASP and post-ASP implementation. The secondary objectives were assessing the reason for inappropriateness and the implemented action in response to inappropriate meropenem prescription.

Result: In total, 113 patients were included. The pre-ASP group included 34 patients; 41 patients were in the first year post-ASP intervention and 38 patients were in the second year post-ASP implementation. There was a significant increase in the number of patients who received appropriate prescriptions in the post-ASP intervention group 2021 and 2022 compared to pre-ASP implementation (26.8%, 53.7% vs 23.5%, p-value 0.002). The most observed reason for inappropriateness in the post-ASP group compared to the pre-ASP group varied (84.8% vs 76.9%, p value 0.53). Discontinuation of treatment in the post-ASP group was higher compared to the pre-ASP group (60% vs. 30.8%, p-value 0.036) meropenem use.

Conclusion: Approximately more than 70% of meropenem prescriptions were inappropriate, and the implementation of ASP shows a significant impact in promoting appropriate meropenem prescription patterns and shorter treatment durations in the ICU.