Carbapenem Stewardship Program in a Cardiovascular Hospital in Tehran, Iran and Literature Review

IntroductionHealthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are critical global challenges. Antimicrobial Stewardship Programs (ASPs) aim to optimize antibiotic use and reduce resistance. This study evaluates carbapenem stewardship compliance in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, emphasizing improved infection control and antibiotic management. MethodologyThis descriptive, cross-sectional study assessed carbapenem antibiotic use compliance with national guidelines in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical Center, Tehran. Seventy patients were selected, and data on demographics, clinical factors, microbiology, and antibiotic use were analyzed using SPSS 26 to evaluate compliance rates and prescribing factors. ResultsThis study analyzed data from 70 patients undergoing open-heart surgery at a cardiovascular hospital in Tehran. The cohort had an equal gender distribution and a mean age of 59.15 years (SD: 12.0). Of the procedures, 51.43% were elective, while 48.57% were emergencies. The most common surgeries included CABG (45.71%) and valvular procedures (30%). Meropenem was the most prescribed antibiotic (92.9%), with prophylactic use noted in 78.57% intraoperatively. Positive cultures identified Candida albicans (32.7%), Klebsiella pneumoniae (29.8%), and Staphylococcus aureus (22.6%) as predominant pathogens. Serum creatinine levels exceeded the normal range in 55.7% of patients, necessitating dosage adjustments. Antibiotic side effects led to treatment discontinuation in 15.7% of cases. ConclusionThis study highlights a high level of rational carbapenem use in a specialized cardiac surgery ICU, with prescribing guided by infectious disease consultations and adherence to guidelines. Implementing antibiotic stewardship programs can further optimize carbapenem use, reduce antibiotic resistance, and improve treatment outcomes, emphasizing the importance of individualized infection management and monitoring in cardiac surgery patients.