{
  "abstract": "Background and Importance Overuse of antibiotics increases resistance, prompting the World Health Organisation to create AWaRe guidelines that classify antibiotics into Access, Watch, and Reserve groups. Carbapenems, in the Watch group, require careful monitoring as part of antimicrobial resistance strategies. Used for specific infections, these broad-spectrum antibiotics should be de-escalated whenever possible to help prevent resistance.Aim and Objectives The objective of this study is to evaluate the degree of de-escalation of a specific carbapenem, meropenem, in a secondary care hospital where 61 carbapenemases were isolated in 2024 (44 OXA48; 6 VIM; 3 KPC; 1 NDM; 4 OXA48 and NDM; 3 OXA48 and VIM).Material and Methods Descriptive, observational, retrospective study from the last quarter of 2024. It included all patients treated with meropenem who had an available antibiogram. Exclusion criteria were absence of culture, negative culture, or death during infection. De-escalation was considered indicated if the antibiogram showed sensitivity to a narrower-spectrum antibiotic to which the patient was not allergic and, in addition, the patient had not had a culture with a multidrug-resistant microorganism in the last 4 months.To conduct the study, the patients‘ electronic medical records were reviewed, collecting demographic variables (sex and age) and clinical variables (prescribing service, duration of treatment, and type of infection).For quantitative variables, measures of central tendency and dispersion were used, and for categorical variables, absolute frequencies.Results A total of 192 patients were reviewed, of whom only 93 met the inclusion criteria, with a median age of 72 years (IQR: 58.75-83.25), 63.4% of them being men. The predominant type of infection was respiratory in origin 37/93 (39.8%), followed by urinary 23/93 (24.7%). The majority of prescriptions were from internal medicine (34.4%), followed by haematology and the ICU (8,6% each). The average treatment duration was 5 days (IQR: 2.83-8.23).Of 93 patients, 11 (11.8%) were ineligible for de-escalation. Among eligible patients, only 61% underwent de-escalation, which means 32 (39%) completed treatment with meropenem even though a narrower-spectrum antibiotic was effective.Conclusion and Relevance The results indicate that antibiotic de-escalation was not performed correctly in all patients analysed, which implies that antibiotic prescribing did not comply with the recommendations made by the AWaRe guidelines.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "I Tabernero Sistines"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "GT Bajenaru"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "G Raguán Yañez"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "IM Sánchez Navarro"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "N Fernández Arberas"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "AG López Del Río"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "M Martín Rodríguez"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "L García Rojo Váquez"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "ME Beltrán Bellvis"
    },
    {
      "affiliations": [
        "Hospital Universitario Príncipe De Asturias, Hospital Pharmacy, Madrid, Spain"
      ],
      "name": "G Baldominos Utrilla"
    }
  ],
  "title": "4CPS-071 Meropenem de-escalation: an approach against bacterial resistance",
  "uid": "e00f16b0-90bc-5351-956d-4b4d0dd07062"
}