1038. Piperacillin/tazobactam- and Cefepime-Based Therapy in Hospitalized Patients and the Risk of Subsequent Isolation of Multidrug-Resistant Organisms (MDRO)
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • WoodsIDW2013.pdf (414.1 kB)
  • Background:

    Piperacillin/tazobactam (PT) and Cefepime (CEF) are both frequently used and effective broad-spectrum agents for the treatment of healthcare-associated infections. Few comparative data exist on the rates of subsequent isolation of MDRO from clinical specimens in PT- and CEF-treated patients (pts).

    Methods:

    A retrospective cohort study was performed on all adult hospitalized pts who received PT or CEF (=target agents) for at least five days at a tertiary care medical center before (6/2010 and 7/2010), during (8/2010 and 9/2010), and after (10/2010 and 11/2010) a hospital-wide replacement of PT with CEF as the preferred broad-spectrum β-lactam. Zero time (ZT) was defined as the day therapy was started. The primary outcome was the subsequent colonization or infection with MDRO including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), gram-negatives resistant to >3 drug classes (GNR), or Clostridium difficile (Cdiff) within the next 90 days. Pts with MDRO isolated prior to or at ZT, pts on additional broad-spectrum agents during therapy with PT or CEF, pts switched from one target agent to the other, or pts who survived <6 days after ZT were excluded. Concomitant vancomycin (VAN) or metronidazole (MET) therapy was permitted. Pts treated with PT were compared to pts treated with CEF with regard to a variety of demographic and clinical characteristics.

    Results:

    A total of 236 pts were included. The median age was 66 years, 145 (61%) were male. The median Charlson comorbidity score was 2. 132 (56%) pts were treated with PT, and 104 (44%) pts were treated with CEF. Both cohorts were very similar with regard to a variety of characteristics including age, length of stay (LOS), type of service, ICU stay, comorbidities, indications for and duration of target therapy, VAN use, and mortality (P>0.2). MDRO (MRSA:n=18; VRE:n=6; GNR:n=20; Cdiff:n=13) were isolated from 26 (20%) PT-treated pts and 24 (23%) CEF-treated pts at a median of 11 days after ZT (P=0.53). MET use was more common in CEF pts, but not associated with MDRO including Cdiff (P=0.36). On logistic regression analyses, LOS between ZT and <90 days was the only predictor of subsequent isolation of MDRO (P<0.001; adjusted OR 1.06, 95% CI 1.04-1.09).

    Conclusion:

    Treatment with PT and CEF resulted in similar risk of subsequent MDRO isolation.

    Krystina Woods, MD, Tomasz Jodlowski, PharmD, BCPS, Manuel Revuelta, MD, Donna Mildvan, MD, David C. Perlman, MD and Jorg Ruhe, MD MPH, Beth Israel Medical Center, New York, NY

    Disclosures:

    K. Woods, None

    T. Jodlowski, None

    M. Revuelta, None

    D. Mildvan, None

    D. C. Perlman, None

    J. Ruhe, 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.