Acceptance and Outcome of Interventions in Meropenem De-esca
A prospective audit and feedback is a method that allows the antimicrobial stewardship program (ASP) team to interact with the attending physicians to tailor antibiotic therapy, including de-escalation, as appropriate. This study aimed to evaluate the acceptance and outcomes of an ASP de-escalation recommendation in children who received meropenem.

Children aged 1 month to 18 years who obtained meropenem in a tertiary care teaching hospital were studied in a prospective cohort sample. The recommendation was made between 72 and 120 hours after beginning meropenem therapy, according to the ASP team. Within 24 hours of the referral, primary physicians' acceptance of the deescalation recommendation was assessed. Clinical success rate at the 7th day and the incidence rate of carbapenem-resistant Gram-negative bacteria (CRGNB) acquisition within 30 days were among the outcomes.

Results:
--217 children with the median (IQR) age of 2.1 (0.6,9.5) years received meropenem.

--The ASP team gave the recommendation as 127 cases of continuation and 90 cases of de-escalation.

--The overall acceptance of ASP de-escalation recommendation was 57.8%.

--The clinical success rates were 85.2% in the accepted group compared to 77.5% in the rejected group.

--The incidence rate of acquisition CR?GNB within 30 days after treatment was 5.8% in the accepted group and 15.8% in the rejected group.

Finally, by ASP intervention, about half of the guidelines to deescalate meropenem prescriptions were approved. In the deescalation community, CRGNB acquisitions were less likely. After the initial 72 hours, a proper deescalation plan for carbapenem use to fight multidrug-resistant species should be encouraged.

Source: https://onlinelibrary.wiley.com/doi/10.1111/ped.14703?af=R
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