56 - Ertapenem Utilization: "CRE"ating Solutions for Improving Hospital Stay and Stewardship

Background: Ertapenem, a carbapenem offers advantages over other carbapenems. It is administered daily and can therefore facilitate home infusion discharges, it has a narrower spectrum of activity which could reduce resistance, and is more cost effective than meropenem. Our objectives were to determine whether ertapenem utilization decreased hospital length of stay and whether use had an impact on future meropenem resistance.

Methods: This was a retrospective chart review of ertapenem over 2 years for the following infections: urinary tract, skin and soft tissue (SSTI), and osteomyelitis. Evaluated pathogens, duration of inpatient therapy, discharged antimicrobials, length of discharged therapy, and positive cultures up to 90 days post treatment. Analyzed length of stay, and calculated the hospital days that were saved by discharging patients on ertapenem.

Results: 70 patients were analyzed, with indications and pathogens listed in Figure 1. Patients were initially placed on empiric therapies pending culture results. On average, patients received 2.9 days of empiric meropenem. Once cultures finalized, patients were switched to ertapenem. On average, patients received 6 days of inpatient ertapenem prior to discharge. 37 patients were discharged with ertapenem, totaling 937 days of discharged therapy. Of the 36 patients readmitted within 90 days, 20 had pathogens identified, of which 4 were meropenem-resistant (Figure 2).Infections, Pathogens, and Treatment Duration


Conclusion: In this pilot stewardship initiative, switching to and discharging patients on ertapenem saved 937 hospital days over the 2 years evaluated, with the greatest days of therapy saved in osteomyelitis and SSTIs. There were a total of 422 days of inpatient ertapenem, mostly in the SSTI and cystitis indications. Of the 20 pathogens identified on readmission, 4 (20%) were meropenem-resistant. All were Acinetobacter baumanii-often carbapenem-resistant; none of the cultures were the same pathogen as the originally identified, but this warrants further investigation. The indication associated with least days of therapy saved and the highest days of inpatient ertapenem was cystitis. 53% of the patients were discharged with ertapenem; future direction involved identifying barriers for speedy discharge across all indications.