Carbapenem Consumption and Use Profile Impacted by a Carbapenem-Sparing Strategy

The increasing use of carbapenems has been associated with the emergence of multidrug-resistant microorganisms, particularly Enterobacterales producing carbapenemases. This highlights the urgency of implementing carbapenem-sparing strategies to preserve antimicrobial effectiveness. To evaluate carbapenem consumption and usage profile in inpatient units following the progressive adoption of the carbapenem-sparing strategy implemented by the antimicrobial stewardship team in 2022. A retrospective analysis was conducted in a pediatric hospital in southern Brazil (CAAE: 68382723.9.0000.5580), assessing meropenem consumption in non-critical clinical wards (15 total), which represent 71% of hospital beds. Consumption was measured using the indicator days of therapy (DOT/1,000 patient-days) between 2022 and 2025, with 2025 data extrapolated from January–June to the full year. Additionally, medical records of all patients receiving meropenem from January to June 2025 were reviewed to assess prescribing patterns. Regarding the 5-year historical series of DOT/1000 patient-days, the results were 562 (2021), 384 (2022), 428 (2023), 334 (2024), and 148 (2025). This demonstrates that the carbapenem-sparing actions, such as case monitoring and daily discussions by the antimicrobial stewardship team were effective, as there were significant reductions in therapy days of 30% (between 2021 and 2022), 22% (from 2023 to 2024), and 55% (estimated from 2024 to 2025). The exception was between 2022 and 2023, when an 11% increase in DOT was observed, which is considered an acceptable variation. Regarding the carbapenem use profile, data from 65 patients corresponded to 95 treatment courses, with a median age of 4.5 years. Empirical use accounted for 61% of cases, while 39% were guided. The ward with the highest indication for meropenem was Infectious Diseases (23% of patients). The mean treatment duration was 6 days, and the main infection sites were bloodstream (32%), urinary tract (21%), and pulmonary (19%). This use profile indicates the presence of patients with some degree of clinical severity in the wards, but with an acceptable treatment duration. Furthermore, the progressive decrease in DOT over the years demonstrates the effectiveness of the carbapenem-sparing strategy.