Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed

Table 1 Score for evaluating carbapenem adequacy

Feature	Question	Answer	Points
Indication^a	Did the patient need carbapenem administration?	Yes No	5 0
Microbial Culture	Have antibacterial susceptibility tests been done before the use of carbapenems?	Yes No	2 0
Single dosage^b	Was the dosage correct according to the Chinese labeling and some references [17, 19, 21]?	Yes No	1 0
Interval^b	Was the interval of carbapenem administration correct according to the Chinese labeling and some references [17, 19, 21]?	Yes No	1 0
Duration^c	Was the duration of therapy correct according to some references [17,18,19,20,21]?	Yes No	1 0
Total score			0–10

^aCarbapenems should be administered to infectious patients with severe sepsis or positive microbial cultures that are (not only) susceptible to carbapenems, or who failure to respond to a broad-spectrum therapy such as piperacillin and tazobactam, or cefoperazone and sulbactam. ^b Regimen and dosage of meropenem: Renally adjusted dose recommendations are based on doses of 0.5 to 2 g every 8 h. eGFR (estimated glomerular filtration rate, ml·min^− 1) > 50, no dosage adjustment necessary; eGFR 26 to 50, administer recommended dose based on indication every 12 h; eGFR 10 to 25, administer one-half recommended dose based on indication every 12 h; eGFR < 10 (or intermittent hemodialysis, or peritoneal dialysis), administer one-half recommended dose based on indication every 24 h; continuous renal replacement therapy, 0.5 g every 8 h or 1 g every 8 to 12 h. Regimen and dosage of imipenem: eGFR > 70, 0.25 to 1 g every 6 h or 0.5 to 1 g every 8 to 12 h; eGFR 41 to 70, 0.25 to 0.5 g every 6 to 8 h or 0.75 g every 8 h; eGFR 21 to 40, 0.25 g every 6 to 12 h or 0.5 g every 6 to 8 h; eGFR 6 to 20 (or intermittent hemodialysis), 0.25 to 0.5 g every 12 h; continuous renal replacement therapy, 0.25 g every 6 h or 0.5 g every 6 to 8 h. ^c The duration would not be rational without an appropriate indication, or if this was shorter than 3 days and without an adequate reason

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