Antimicrobial stewardship principles in the evaluation of empirical carbapenem antibiotics in a private hospital in South Africa

Introduction: Antimicrobial resistance, and specifically carbapenem resistance, have developed into a major challenge globally. Because carbapenems are used increasingly as empirical treatment in the presence of rising ESBL infection, the aim of this study was to determine rational prescribing patterns for empirical use of carbapenems. Clinical guidelines are essential in ensuring responsible use in the local context and are one of the most important elements of antibiotic stewardship programmes. Methods: A retrospective descriptive review of empirical carbapenem use was conducted by reviewing records of participants from an electronic dispensing system and infection prevention pharmacy system. A data collection sheet, which outlines carbapenem utilization evaluation in a large community hospital, was used. Results were analysed descriptively using SPSS (V28) and reported as percentages and frequencies, to provide an overview of the problem. Results: A total of 450 records were reviewed. Ertapenem was the most frequently prescribed empirical carbapenem. Empirical carbapenem therapy was prescribed mainly for respiratory tract and intra-abdominal infections. Only 15 ESBL-producing organisms were cultured out of the 104 positive cultures. The majority of patients continued with empirical carbapenem therapy despite negative cultures and decreased or normal values of C-reactive protein, procalcitonin and WBC count. Carbapenem prescribing did not comply with guidelines in 70% of the study population, and de-escalation happened in only eight patients. Conclusions: Antimicrobial stewardship principles were mostly followed, except for correct indication of the antibiotic and de-escalation after culture results. This provided a potential opportunity for intervention to optimize de-escalation to non-carbapenem antibiotics.