1041. Effect of Piperacillin/tazobactam Restriction on Prescribing Habits and Rates of Acute Renal Failure
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • MUE 2013 Final Poster_ID Week.pdf (611.0 kB)
  • Background:

    Piperacillin/tazobactam (PT) was found to be a frequent empiric antibiotic choice and possibly associated with an elevated risk of acute renal failure (ARF) at the VA St. Louis Health Care System.  On 15 July 2012, PT was restricted, requiring clinical pharmacy or infectious diseases approval for durations exceeding 72 hours.

    Methods:

    A retrospective cohort was undertaken to determine if this restriction decreased PT usage and/or rates of ARF (defined as a 50% increase or 0.5 mg/dL increase in serum creatinine from baseline).  Patients prescribed at least 1 day of PT with a creatinine clearance (CrCl) >39 mL/min at the time of initiation in the 3 months prior to the restriction (15 April – 30 June 2012) were compared to patients receiving at least 1 day of PT with a CrCl >39 mL/min in the 5 months after restriction implementation (1 August – 31 December 2012). 

    The number of days of PT therapy in the pre- and post-implementation groups, along with rates of ARF, were compared.   

    Results:

    Overall, 115 unique patients were included in the pre-implementation group and compared to 117 unique patients in the post-implementation group. The pre-implementation group received an average of 5.22 days of PT, compared to 4.71 days in the post-implementation group (P=0.224). 

    Ten percent (12/120) of patients in the pre-implementation group developed ARF compared to 9.01% (11/122) of patients in the post-implementation group (P=0.0309). Potential confounders for renal function were evaluated at baseline (use of loop diuretics, angiotensin converting enzyme inhibitor therapy, co-administration of aminoglycosides, and contrast administration during hospitalization) and were not significantly different between groups.  Ninety five patients in the pre-implementation group and 91 in the post-implementation group received combination therapy with vancomycin.  ARF occurred in 11.6% (11/95) of those in the pre-implementation group and 12.1% (11/91) in the post-implementation (P>0.05).  Overall, 11.8% (22/186) of patients who received therapy with PT and vancomycin developed ARF, compared to 1.7% (1/56) who received PT monotherapy (P<0.0001).  

    Conclusion:

    This restriction resulted in a numeric reduction in the number of PT days in the post-implementation group, and a significant reduction in the rate of ARF.

    Michael A. Lorenz, Pharm.D.1,2, Ryan P. Moenster, Pharm.D.3 and Travis W. Linneman, Pharm.D.3, (1)Pharmacy Services, St. Louis VA Medical Center - John Cochran Division, Saint Louis, MO, (2)Pharmacy Practice, Saint Louis College of Pharmacy, Saint Louis, MO, (3)Pharmacy Services/Medicine Specialty Care, St. Louis VA Medical Center - John Cochran Division, St. Louis, MO

    Disclosures:

    M. A. Lorenz, None

    R. P. Moenster, None

    T. W. Linneman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.