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The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Clostridium difficile Risk in 88 US

Alan E Gross1,2, Richard S Johannes3,4, Vikas Gupta3

  • 1Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|April 27, 2017
PubMed
Abstract

Insights

During piperacillin/tazobactam shortages, switching to high-risk antibiotics increased hospital-onset Clostridium difficile infection (HO-CDI) rates. Antibiotic stewardship is crucial for managing drug shortages and preventing adverse events like HO-CDI.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Antimicrobial Stewardship

Background:

  • Drug shortages, particularly for essential anti-infectives like piperacillin/tazobactam (PIP/TAZO), are a significant challenge in US healthcare.
  • These shortages can disrupt treatment protocols and potentially lead to increased use of alternative antibiotics with higher risks for adverse events.

Purpose of the Study:

  • To investigate the association between piperacillin/tazobactam (PIP/TAZO) shortages and the incidence of hospital-onset Clostridium difficile infection (HO-CDI).
  • To determine if changes in prescribing patterns, specifically increased use of high-risk antibiotics during PIP/TAZO shortages, correlate with HO-CDI rates.

Main Methods:

  • Analysis of electronic microbiology and antibiotic utilization data from 88 US hospitals between July 2014 and June 2016.
  • Utilized a Poisson model to assess the risk of HO-CDI associated with PIP/TAZO shortages, controlling for hospital characteristics and shifts in antibiotic use.
  • Examined changes in antibiotic usage patterns as a secondary outcome.

Main Results:

  • Of 88 hospitals experiencing PIP/TAZO shortages, 72 showed increased use of high-risk antibiotics.
  • The adjusted relative risk (RR) for HO-CDI during PIP/TAZO shortages was not statistically significant (RR=1.03, P=.73).
  • Hospitals experiencing both a PIP/TAZO shortage and a shift to high-risk antibiotics had a significantly increased adjusted RR of HO-CDI (RR=1.30, P<.05).

Conclusions:

  • Shifting antibiotic prescribing to agents with higher Clostridium difficile infection (CDI) risk during piperacillin/tazobactam (PIP/TAZO) shortages is linked to increased rates of hospital-onset CDI (HO-CDI).
  • This highlights a critical adverse consequence of drug shortages and underscores the vital role of robust antibiotic stewardship programs in mitigating risks during such events.
Keywords:
Clostridium difficiledrug shortagepiperacillin/tazobactam

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