An Overview about Carbapenem-Sparing Strategies

Abstract

Antimicrobial stewardship involves optimizing antibiotic use while using cost-effective interventions to minimize antibiotic resistance and control Clostridium difficile infection. For decades before the widespread introduction of antimicrobial stewardship programs (ASPs), infectious disease (ID) clinicians have been the antibiotic stewards in hospitals. Recently, the Centers for Disease Control and Prevention (CDC) has mandated and codified ASPs for all US hospitals. The CDC has based its ASP recommendations on 7 key elements. Firstly, the hospital must designate a single ID clinician who will direct the hospital’s ASP efforts. To be effective, the ID clinician leader must possess the requisite interpersonal, diplomatic, and leadership skills that are the basis for the enthusiastic support of the medical staff. The ID clinician leader should have special expertise in various aspects of antimicrobial therapy, that is, pharmacokinetics, resistance, pharmacoeconomics, and C difficile. To head an effective hospital-wide ASP, the ID ASP team leader needs full and ongoing financial support for the ASP from the hospital administration. Support includes a staff of ID-trained clinical pharmacists, a vital component of ASPs. The ID team leader and clinical pharmacists need committed information technology (IT) support, that is, prospective audits, data collection to track and monitor antibiotic resistance and C difficile, as well as ASP cost savings to the institution. Furthermore, carbapenem-sparing strategies have generated substantial debate and are advocated with judicious use of novel antibiotics,antibiotic stewardship programs, proper measures of infection control, staff educational programs and care bundels.