A multi-site observational study of rationality assessment for carbapenem use in China: carbapenem stewardship opportunities.

INTRODUCTION: Carbapenems are key antibiotics for treating severe infections caused by Gram-negative bacteria. However, the irrational use of carbapenems has raised serious concerns regarding the emergence of carbapenem-resistant organisms. This study aimed to assess the rationality of carbapenem use and to identify opportunity of improvement. METHODS: A multi-site, observational, retrospective study was conducted in 10 hospitals in Sichuan, China. All emergency and hospitalized patients treated with carbapenems between November 1 and December 31, 2021, were included. The rationality of carbapenem use was evaluated from three aspects: necessity for empiric treatment, appropriateness for targeted therapy, and optimization for the regime. RESULTS: A total of 138,092 cases were screened and 2,028 received a carbapenem, corresponding to an overall use rate of 1.5%. There were 1,908 cases eligible for assessment comprising 1,729 (90.6%) empiric and 179 (9.4%) targeted treatment. Unnecessary use was identified in 502 cases (29.0%) with empiric treatment, most of which used irrationally for mild to moderate infections. Inappropriate use was found in 58 (32.4%) receiving targeted therapy, mostly because of treating infections with other recommended options (n = 49). Optimization issues were uncovered in 256 (13.4%) of 1,908 cases, commonly due to lack of microbiological testing or improper dose adjustment. CONCLUSION: A considerable proportion of carbapenem use in the participating hospitals was irrational. Carbapenem stewardship on avoiding unnecessary use in mild/moderate infections and inappropriate applications in those with other recommended options, improving microbiological testing, and optimizing dosage regimens are needed to promote rational carbapenem use.