Consecutive Antibiotic Shortages Highlight Discrepancies between Microbiology and Prescribing Practices for Intra-abdominal Infections
| Autor: | Amy J. Mathers, Heather L. Cox, Kasi Vegesana, Grace R Gillis-Crouch, Lindsay Donohue, Stacy C Park, Rena Morse |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.drug_class
intra-abdominal infection Cefepime Antibiotics Economic shortage Microbiology Epidemiology and Surveillance 03 medical and health sciences 0302 clinical medicine fluids and secretions antibiotic shortage polycyclic compounds cefepime Medicine Infection control Pharmacology (medical) 030212 general & internal medicine Pharmacology 0303 health sciences 030306 microbiology business.industry Abdominal Infection Antimicrobial National guideline female genital diseases and pregnancy complications antimicrobial prescribing antimicrobial stewardship Infectious Diseases embryonic structures Ceftriaxone piperacillin-tazobactam business medicine.drug |
| Zdroj: | Antimicrobial Agents and Chemotherapy |
| ISSN: | 1098-6596 0066-4804 |
| Popis: | 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. 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 prescriber 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 1-year periods: preshortage, TZP shortage, cefepime shortage, and postshortage. 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 Clostridioides 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 antipseudomonal 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. |
| Databáze: | OpenAIRE |
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