55 - Ertapenem for Surgical Prophylaxis: The Impact of Antimicrobial Stewardship Interventions on Inappropriate Carbapenem Utilization at a Community Teaching Hospital

Background: Internal analysis of ertapenem utilization revealed overuse for surgical prophylaxis in intra-abdominal (IA) procedures. Our Antimicrobial Management Team (AMT) initiated a multimodal intervention to promote the appropriate use of ertapenem. The primary objective of this study is to describe and evaluate the impact of our interventions targeting ertapenem utilization for IA surgical prophylaxis.

Methods: From March to October 2019, a pre-post study was performed to evaluate ertapenem utilization for surgical prophylaxis. Our AMT interventions which were formally implemented in June 2019 included the following: targeted provider feedback, review and update of our surgical prophylactic antibiotic protocol (SPAP), policy, and order set addition of Cefoxitin to formulary, extensive provider education, and monitoring of SPAP compliance. Data was abstracted from the electronic medical record for IA cases and included antibiotics prescribed, procedure type, and prescriber information. In addition, surgical site infection (SSI) rates and Clostridium difficile infection rates were monitored throughout the study period.

Results: In total, 1,080 IA surgical cases were reviewed. The set quality measure of less than 5 percent ertapenem utilization was achieved each month after AMT interventions in June 2019, as demonstrated by monthly ertapenem use for surgical prophylaxis: 13.7 percent in March, 13.4 percent in April, 4.9 percent in May, 8.9 percent in June, 3.1 percent in July, 2.2 percent in August, 4.5 percent in September, and 3.4 percent in October. Overall, the number of ertapenem cases was 58 pre-study (March to June) versus 16 post-study (July to October), accounting for a 72.4 percent reduction in ertapenem utilization for IA surgical prophylaxis. The rate of SSI among IA surgeries and Clostridium difficile infection did not increase as a consequence of our interventions

Conclusion: Carbapenem use for surgical prophylaxis was consistently within threshold limits following the stewardship interventions. Incidence of surgical site infections and Clostridium difficile infection did not increase during the interventions suggesting that alternate antimicrobial agents in the SPAP are safe and effective for IA surgeries in our patient population.