Improving meropenem prescribing through antimicrobial stewardship interventions: a prospective clinical audit in a UK district general hospital
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Objectives Carbapenem stewardship is a key priority in the global response to antimicrobial resistance. We evaluated meropenem prescribing and the impact of antimicrobial stewardship interventions in a UK district general hospital. Methods We conducted a prospective clinical audit of adult inpatient meropenem prescribing over three sequential phases: a baseline audit, an intervention phase, and a re-audit. Consecutive meropenem prescriptions were assessed against local antimicrobial guidelines for prescribing compliance, documentation of indication and treatment duration, and recording of penicillin allergy status. The intervention comprised daily multidisciplinary antimicrobial stewardship ward rounds, prospective audit with real-time feedback, and focused prescriber education. Data were analysed descriptively using counts and percentages. Results Across the audit cycle, 300 meropenem prescriptions were reviewed. Comparative outcome data were analysed for the baseline and re-audit phases (100 prescriptions each). Baseline guideline compliance was 50% (50/100), with 50% (50/100) of prescriptions classified as non-compliant. Documentation of indication and treatment duration was recorded in 86% (86/100) and 94% (94/100) of prescriptions, respectively. Following the intervention, guideline compliance increased to 74% (74/100), while non-compliant prescribing decreased to 26% (26/100). Documentation of both indication and treatment duration improved to 100% (100/100). A documented penicillin-allergy label was present in 69% (69/100) of patients at baseline and 53% (53/100) in the re-audit cohort. In the re-audit phase, 11% (11/100) of prescriptions were associated with microbiologically confirmed ESBL- or AmpC-producing Enterobacterales. Conclusions Targeted antimicrobial stewardship interventions improved meropenem prescribing practice and documentation standards. Prospective audit combined with real-time feedback represents a practical strategy for optimising carbapenem use and strengthening antimicrobial stewardship in acute hospital settings.
