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Shifts in antimicrobial consumption and infection rates before and during a piperacillin/tazobactam shortage
S Travis King1, Katie E Barber2, Jason J Parham3
1Department of Pharmacy Practice, University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS 39216, USA; Department of Medicine-Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Objectives:
Anti-infective shortages represent a growing threat to optimum management of infected patients and alter the institutional selective pressure against hospital-acquired infections (HAIs). The objective of this analysis was to assess the impact of a shortage of piperacillin/tazobactam (TZP) on overall antibacterial use and HAI rates at an academic institution.
Methods:
Antimicrobial use and infection data were extracted from TheraDoc Clinical Surveillance Software (Premier, Inc.) for adult patients and were stratified as pre-shortage (October-December 2014) and post-shortage (February-April 2015). Paediatric and emergency department use were excluded. Antimicrobial use was reported as percent change and defined daily doses (DDD)/1000 patient-days (PD). Pre- and post-shortage vancomycin-resistant enterococci (VRE) and Clostridium difficile-associated diarrhoea (CDAD) rates were normalised to 1000 PD/month.
Results:
Total use of target antimicrobials remained constant before and after TZP shortage (990.29 vs. 957.77). Total TZP use fell 95.2% (81.1 vs. 3.9). Total meropenem use rose 96.0% (42.3 vs. 82.9) after the shortage, driven by a 125.4% increase in use for non-ICU patients. Cefepime and ceftazidime use rose 97.9% (28.2 vs. 55.8) and 94.2% (1.6 vs 3.0), respectively. Cefepime use in non-ICU patients rose 223.2%. Fluoroquinolone consumption did not differ between periods. CDAD rates decreased (-21.8%), whilst VRE rates doubled during the shortage (0.6 vs. 1.3 infections/1000 PD/month).
Conclusions:
Whilst overall antimicrobial use appeared steady, the TZP shortage resulted in increased use of multiple other antimicrobials. The doubling of VRE rates is concerning and illustrates the need for increased antimicrobial stewardship vigilance and education in response to shifting prescribing patterns during shortages.
Insights
A piperacillin/tazobactam shortage led to increased use of other antibiotics and a concerning doubling of vancomycin-resistant enterococci (VRE) rates, highlighting the need for antimicrobial stewardship.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Antimicrobial Stewardship
Background:
- Anti-infective shortages pose a significant challenge to patient care and infection control.
- Hospital-acquired infections (HAIs) are a growing concern, influenced by antimicrobial prescribing patterns.
Purpose of the Study:
- To evaluate the impact of a piperacillin/tazobactam (TZP) shortage on overall antibiotic consumption and HAI rates.
- To analyze shifts in antimicrobial prescribing at an academic institution during a drug shortage.
Main Methods:
- Retrospective analysis of adult patient antimicrobial use and infection data (pre- and post-shortage periods).
- Data extracted from clinical surveillance software, measuring antimicrobial use in defined daily doses (DDD)/1000 patient-days (PD).
- Vancomycin-resistant enterococci (VRE) and Clostridium difficile-associated diarrhoea (CDAD) rates normalized to 1000 PD/month.
Main Results:
- Total antimicrobial use remained stable, but TZP use decreased by 95.2%.
- Meropenem, cefepime, and ceftazidime use significantly increased, particularly in non-ICU settings.
- Clostridium difficile-associated diarrhoea rates decreased by 21.8%, while vancomycin-resistant enterococci rates doubled.
Conclusions:
- The TZP shortage prompted increased use of alternative broad-spectrum antibiotics.
- The doubling of VRE rates underscores the critical need for enhanced antimicrobial stewardship and education during drug shortages.
- Shifting prescribing patterns during shortages can have unintended consequences on resistance development.
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