1821. Adverse Events associated to Piperacillin-Tazobactam Use in Children with Cystic Fibrosis
Session: Poster Abstract Session: Respiratory Infections: Potpourri
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • PipTazoPoster2_cq.pdf (265.7 kB)
  • Background: Pulmonary exacerbations – where P. aeruginosa plays an important role –  are the leading cause of morbidity and mortality in patients suffering from Cystic Fibrosis (CF). While intravenous Piperacillin/Tazobactam (PT) treatment is widely used, it is perceived as causing adverse events (AE) at a greater frequency and severity than other beta-lactams. We aimed to understand the characteristics of children with CF who developed AEs to PT.

    Methods: The CF clinic at the Montreal Children’s Hospital follows a cohort of 80 children. We retrieved all admissions for children with CF (pulmonary exacerbations) from 1990 to April 2013 and crossed the admissions with the pharmacy-dispensing database to select admissions where PT was prescribed. Charts from patients who had received at least one course of PT (lifetime) were reviewed. Using a standardized case report form, we collected data from each admission including demographic, clinical, treatment and outcomes characteristics. PT AEs were defined as: fever or rash or serum sickness-like reaction (≥ 3 of: fever, arthralgia or arthritis, urticarial rash, lymphadenopathy, or nausea/vomiting) that occurred after treatment onset.

    Results: Of 25 patients and 43 admissions included in the study, 5 patients (20% of patients, 11.6% of admissions) demonstrated a possible PT-induced AE; 4 patients (16% of patients, 9.3% of admissions) experienced fever, 3 patients (12% of patients, 7.0% of admissions) experienced rash, and 1 patient (4% of patients, 2.3% of admissions) experienced serum sickness with febrile neutropenia (leukopenia preceded fever). The patient experiencing serum sickness received a statistically higher dose of PT than those who did not experience serum sickness (600 vs. 265.8 mg/kg/day, above 99.7th Confidence Interval). Patients experiencing rash also tended to be receiving higher doses of PT (322 vs. 271.5 mg/kg/day) but had lower previous exposure to PT (163.5 vs. 256.0 mg/kg/day, p= 0.0147).  

    Conclusion: There may be a need to limit the dose of PT administered to patients with CF and optimize pharmacodynamics properties of PT (prolonged infusion). Comparing the relative risk of AEs between PT and other beta-lactams in this population is needed.

    Natalie Mathews, MDCM1, Sondos Zayed, MDCM (C)1, Larry C. Lands, MD FRCPC2, Adam Shapiro, MD FRCPC2, Justine Cote, BPharm, MSc3, Catherine Sicard, BPharm, MSc3 and Caroline Quach, MD, MSc, FRCPC, FSHEA4, (1)McGill University Heatlh Center, Montreal, QC, Canada, (2)Pediatric Respirology, McGill University Heatlh Center, Montreal, QC, Canada, (3)Pharmacy, McGill University Heatlh Center, Montreal, QC, Canada, (4)Infection Control & Prevention, McGill University Health Center, Montreal, QC, Canada

    Disclosures:

    N. Mathews, None

    S. Zayed, None

    L. C. Lands, None

    A. Shapiro, None

    J. Cote, None

    C. Sicard, None

    C. Quach, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.