Background:

Carbapenem-resistance enterobacteriaceae (CRE) incidence was persistently high in Hospital Serdang in the past two years (21 cases). Studies show inappropriate use of carbapenem leads to emergence of carbapenem-resistant bacteria.

Methods:

This study aimed to evaluate and improve appropriateness of carbapenem use in Hospital Serdang. The study was carried out involving two phases. First phase was done in January 2018 that empirical carbapenem prescriptions ordered in period of November 2017 until January 2018 were audited for its appropriateness. Data was retrieved from prescriptions, carbapenem order form database and medical records review. Appropriateness of carbapenem use was determined according to pre-specified criteria. Second phase of the audit was done in August after few remedial actions taken and the result was compared with first audit.
 

Results:

A total of 39 empiric carbapenem prescriptions were audited in first phase. Result showed only 15.4% of carbapenem use was appropriate, which fulfilled all criteria of correct use (indication, dose, route, duration, de-escalation, microbiological sample taken). 42% of the prescriptions were inappropriate indication and only 30.8% of the prescriptions were de-escalated appropriately on day 4. Few remedial actions were taken such as incorporation of pre-prescribing checklist into carbapenem order form and daily review of carbapenem prescription by multidisciplinary team. Re-audit results showed improvement of appropriateness of carbapenem use from 15.4% to 81.1%.

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Conclusions:

Good prescribing practice, daily review of carbapenem prescription and multidisciplinary teamwork were proven to improve appropriateness of carbapenem use.