Carbapenem stewardship: positive impact on hospital ecology

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

Report of Recommendations to the Iowa Department of Agriculture and Land Stewardship, June 30, 2002

State Agency Audit Report

Report of Recommendations to the Iowa Department of Agriculture and Land Stewardship, June 30, 2003

State Agency Audit Report

Report of Recommendation to the Iowa Department of Agriculture and Land Stewardship, June 30, 2004

State Audit Reports

Report of Recommendations to the Iowa Department of Agriculture and Land Stewardship, June 30, 2005

State Audit Reports

Audit report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2006

Audit report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2006

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2007

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2007

Call for Proposals Iowa Department of Agriculture and Land Stewardship Division of Soil Conservation, August 31, 2012

IDALS stands for Iowa Department of Agriculture and Land Stewardship. IDALS’s mission is to provide leadership for all aspects of agriculture in Iowa, ensure consumer protection and promote the responsible use of our natural resources. DSC stands for the Division of Soil Conservation and is the division within IDALS responsible for state leadership in the protection and management of soil, water and mineral resources. Learn more about IDALS at www.iowaagriculture.gov

Review of the Abandoned Mined Land Reclamation program administered by the Department of Agriculture and Land Stewardship for the period July 1, 2003 through June 30, 2008

Review of the Abandoned Mined Land Reclamation program administered by the Department of Agriculture and Land Stewardship for the period July 1, 2003 through June 30, 2008

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2008

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2008

Department of Agriculture and Land Stewardship Facts FY2007

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data.

Department of Agriculture and Land Stewardship Facts FY2007

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Department of Agriculture and Land Stewardship Facts FY2008

These Facts sheets have been developed to provide a multitude of information about executive branch agencies/departments on a single sheet of paper. The Facts provides general information, contact information, workforce data, leave & benefits information, and affirmative action data. This is the most recent update of information for the fiscal year 2007.

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2009

Report on the Iowa Department of Agriculture and Land Stewardship for the year ended June 30, 2009

Report on a review of the Fuel Inspection Program administered by the Iowa Department of Agriculture and Land Stewardship for the period July 1, 2005 through June 30, 2009

Report on a review of the Fuel Inspection Program administered by the Iowa Department of Agriculture and Land Stewardship for the period July 1, 2005 through June 30, 2009