Consecutive antibiotic shortages highlight discrepancies between microbiology and prescribing practices for intra-abdominal infections.

Autor:	Park SC; Division of Infectious Diseases and International Health. Department of Medicine, University of Virginia Health System. Charlottesville, Virginia, USA. sc5ma@hscmail.mcc.virginia.edu., Gillis-Crouch GR; Division of Infectious Diseases and International Health. Department of Medicine, University of Virginia Health System. Charlottesville, Virginia, USA., Cox HL; Department of Pharmacy Services, University of Virginia Health System. Charlottesville, Virginia, USA., Donohue L; Department of Pharmacy Services, University of Virginia Health System. Charlottesville, Virginia, USA., Morse R; Health Information & Technology, University of Virginia Health System. Charlottesville, Virginia, USA., Vegesana K; Health Information & Technology, University of Virginia Health System. Charlottesville, Virginia, USA., Mathers AJ; Division of Infectious Diseases and International Health. Department of Medicine, University of Virginia Health System. Charlottesville, Virginia, USA. ajm5b@virginia.edu.; Clinical Microbiology Laboratory. Department of Pathology, University of Virginia Health System. Charlottesville, Virginia, USA.
Jazyk:	angličtina
Zdroj:	Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2023 May 01; Vol. 95 (5). Date of Electronic Publication: 2021 Feb 16.
DOI:	10.1128/AAC.01980-20
Abstrakt:	Piperacillin-tazobactam (TZP) is frequently used for intra-abdominal infection (IAI). Our institution experienced consecutive shortages of TZP and cefepime, providing an opportunity to review prescribing patterns and microbiology for IAI. Hospitalized adult patients treated for IAI, based on provider selection of IAI as the indication within the antibiotic order, between March 2014 and February 2018 were identified from the University of Virginia Clinical Data Repository and Infection Prevention and Control Database. Antimicrobial utilization, microbiologic data, and clinical outcomes were compared across four year-long periods: pre-shortage, TZP shortage, cefepime shortage, and post-shortage. There were 7,668 episodes of antimicrobial prescribing for an indication of IAI during the study period. Cefepime use for IAI increased 190% during the TZP shortage; meanwhile ceftriaxone use increased by only 57%. There was no increase in in-house mortality, colonization with resistant organisms, or Clostridiodes difficile infection among patients treated with IAI during the shortage periods. Among a subset of cases randomly selected for review, Pseudomonas sp. was a rare cause of IAI, but anti-pseudomonal antibiotics were commonly prescribed empirically. We observed a large increase in cefepime utilization for IAI during a TZP shortage that was not warranted based on the observed frequency of identification of Pseudomonas sp. as the causative organism in IAI, suggesting a need to revisit national guideline recommendations. (Copyright © 2021 Park et al.)
Databáze:	MEDLINE
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