Reducing carbapenem prescribing in high-use settings: it is possible, and it is good to talk
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 , and carbapenem use at a patient level is associated with risk of resistant infection . 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.  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...
Nicola Fawcett is supported by a Medical Research Council UK Clinical Research Training Fellowship [MR/M003736/1].
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