Investigation on the Use and Preauthorization of Carbapenems at A National Hospital in Vietnam: A Cross-Sectional Study

Abstract

Carbapenems, known for their broad-spectrum activity and used as last-line treatment for severe drug-resistant infections, are encountering increasing resistance. Therefore, Thong Nhat Hospital, a national hospital in Vietnam, has implemented the preauthorization of some restricted antibiotics, including carbapenems, to optimize their use on patients. This study aimed to investigate the current use and preauthorization of carbapenems at the hospital. This descriptive cross-sectional study was conducted on the medical records of inpatients having at least one order form for carbapenems from December 2023 to February 2024 at Thong Nhat Hospital. The data regarding microbiological features, carbapenem resistance patterns, characteristics of the use and preauthorization of carbapenems, and treatment outcome were collected for analysis. A total of 348 patients were selected for the study. The median age of patients was 69 years. Escherichia coli was the most frequently isolated Gram-negative bacteria, and Acinetobacter baumannii had the lowest susceptibility to carbapenems. The appropriate rate of carbapenem regimens regarding the hospital guideline was 68.10%. Optimizing dosing was the most common intervention in preauthorization. The rate of patients whose preauthorization process of all restricted antimicrobials complied with the hospital's protocol was 73.28%. Factors associated with lower treatment success included high Charlson score and diagnoses of septic shock, respiratory tract infection, and central nervous system infection. The preauthorization of carbapenems should be enhanced to optimize the appropriate use of carbapenems, particularly in patients with multiple comorbidities and severe infections.

Keywords: carbapenems; preauthorization; treatment outcome.