Antimicrobial Stewardship Programs Approach to Managing Critical Antimicrobial Shortages
Background: Antimicrobial shortages pose significant logistical and clinical challenges, including the potential for inferior clinical outcomes when alternative agents must be used. In the fall of 2015, a critical doripenem shortage prompted us to formalize our approach to antimicrobial shortage management.
Methods: Upon doripenem shortage detection in October 2015, there were 35 patients with active doripenem orders at our institution. The Antimicrobial Stewardship Program (ASP) pharmacists were the first to receive notification of the issue which prompted development and assembly of a critical shortage team to carry out a cascade of events aimed at converting therapy to alternative agents, optimizing stock of these agents, limiting or preventing continued prescribing of doripenem (stringent restriction), monitoring use of doripenem and high cost alternative agents, replenishing doripenem supply, and communicating the situation to all affected parties (Figure 1). Members of the critical shortage team included ASP pharmacists and physicians, medication purchasing staff, the microbiology laboratory directors, and information technology personnel. Upon shortage resolution, restrictions were lightened.
Results: The ASP successfully converted 31 of 35 (89%) patients on doripenem to alternative agents within 24 hours of shortage notification resulting in no known adverse outcomes. Four patients remained on doripenem due to lack of appropriate alternative therapies. Twelve patients were newly initiated on doripenem during the first 30 days of the shortage period via the restriction pathway. Average doripenem days of therapy per 1,000 patient days decreased from 16 in the 30 days pre-shortage to 4 in the first 30 days of the shortage. Doripenem supply re-stabilized in January 2016 at which time the more stringent restriction was lifted.
Conclusion: As a result of a critical doripenem shortage, a systematic approach to antimicrobial shortages was developed. This algorithm will streamline the process for managing critical antimicrobial shortages in the future.
Figure 1. Critical shortage team and their respective responsibilities
P. Srinivas, None
K. Stevenson, None
K. Wetz, None
K. Nagendran, None
P. Pancholi, None
J. M. Balada-Llasat, None