Effects of Carbapenem Restriction on the Prevalence of Carbapenem-Resistant Acinetobacter baumannii Infection in Adult General Wards

Background Recently, there has been a significant increase in the number of nosocomial infections caused by the carbapenem-resistant Acinetobacter baumannii (CRAB) pathogen, subsequently increasing mortality and morbidity. This infection is usually observed in intensive care units. However, in our hospital, we have experienced an increasing number of CRAB infection cases in adult general wards. Carbapenem use is considered a contributing factor. Therefore, we examined the restriction of carbapenem use in adult general wards as a strategy to decrease the prevalence of CRAB infection. Methods The study was divided into 2 periods: carbapenem-nonrestricted period and carbapenem-restricted period. During the carbapenem-nonrestricted period, data of CRAB infection cases and carbapenem consumption were collected retrospectively between February 1, 2016, and January 31, 2017. During the carbapenem-restricted period, the same data were collected prospectively from February 1, 2017, to January 31, 2018. The amount of carbapenem consumed was measured as daily defined doses per 1000 patient days. Results The numbers of admitted patients during the carbapenem-nonrestricted and carbapenem-restricted periods were 7501 and 8062, respectively. The average amount of carbapenem consumption reduced from 1.35 defined daily doses/1000 to 0.125 defined daily doses/1000 patient days. During the carbapenem-nonrestricted period, 31 CRAB infection cases exhibited isolated CRAB. After the carbapenem-restricted period, only 14 CRAB infection cases were reported (P = 0.005). Conclusions Implementing carbapenem restriction can be an effective strategy to decrease the prevalence of CRAB infection, subsequently decreasing mortality. However, the stewardship of other groups of antibiotics, which can be used as alternatives to carbapenems, is important to avoid the emergence of other bacterial strains.