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Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1179–1180 | Cite as

Reducing carbapenem prescribing in high-use settings: it is possible, and it is good to talk

  • Nicola Jane Fawcett
IM - COMMENTARY

The importance of reducing unnecessary use of antibiotics, especially our ‘last line’ agents, cannot be overstated. Higher use of carbapenems at a country and institutional level has been shown to correlate with higher rates of resistance [1], and carbapenem use at a patient level is associated with risk of resistant infection [2]. Yet overuse of these crucial antibiotics is widespread. Changing, and reducing, antibiotic use has proved a major challenge, so success stories are welcome.

In this issue, Fortini et al. [3] demonstrate a sizeable reduction in carbapenem use, and antibiotic use overall, in an Italian institution 2015–2016. Whilst this is a relatively small study involving a single institution, they show an impressive 80% reduction in carbapenem use, in an institution where they note up to 46% of their Klebsiella pneumoniae isolates are resistant to carbapenems, and 44% of Escherichia coli isolates resistant to third-generation cephalosporins.

A higher-than-average use of...

Notes

Funding

Nicola Fawcett is supported by a Medical Research Council UK Clinical Research Training Fellowship [MR/M003736/1].

Compliance with ethical standards

Conflict of interest

The author states that they have no conflicts of interest.

Statement of human and animal rights

The article does not contain any studies with human participants or animals performed by the author.

Informed consent

None.

References

  1. 1.
    McLaughlin M, Advincula MR, Malczynski M, Qi C, Bolon M, Scheetz MH (2013) Correlations of antibiotic use and carbapenem resistance in enterobacteriaceae. Antimicrob Agents Chemother 57:5131–5133CrossRefGoogle Scholar
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    Falagas ME, Rafailidis PI, Kofteridis D et al (2007) Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. J Antimicrob Chemother 60:1124–1130CrossRefGoogle Scholar
  3. 3.
    Fortini A, Faraone A, Di Pietro M et al (2018) Antimicrobial stewardship in an Internal Medicine ward: effects on antibiotic consumption and on the use of carbapenems. Intern Emerg MedGoogle Scholar
  4. 4.
    Davey P, Marwick CA, Scott CL et al (2017) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2:CD003543PubMedGoogle Scholar
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    Pinder RJ, Sallis A, Berry D, Chadborn T (2015) Behaviour change and antibiotic prescribing in healthcare settings: literature review and behavioural analysis. Department of Health, Public Health England, London.  https://doi.org/10.13140/RG.2.1.4657.4245

Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Nuffield Department of MedicineJohn Radcliffe Hospital, University of OxfordOxfordUK
  2. 2.Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxfordUK

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