983. Detailed Piperacillin-Tazobactam Use Audit in a North American Tertiary Care Hospital: Not Necessarily Wrong, Not Quite Right: Directions for Stewardship
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall

Background:

Antimicrobial resistance is a global concern and stewardship programs have been recommended as an evidence based method of improving prescribing. Piperacillin-tazobactam (PT) is the most common parenteral broad spectrum agent used in Canadian hospitals, increasing more than 10 fold from 2002-14 (28.17 DDD/1000 to 295.46 DDD/1000 discharges.) Given this increase and PT’s broad spectrum, we decided to assess PT as a stewardship target. 

Methods:

A prospective audit was performed, on all PT orders on adult inpatients July 3-29, 2015 at a large teaching tertiary hospital (651 adult beds) with chart review for demographics, clinical parameters, rationale for PT initiation, antimicrobials, pertinent cultures, and outcomes. Two investigators assessed guideline concordance with standard provincial guidelines, and whether concordant use was optimal (based on local guidelines suggesting other agents as first line), with resolution of differences by consensus review.

Results:

Of 149 new PT starts assessed, 64% were guideline concordant, 23%were not guideline concordant, and 13% were suboptimal, with services shown in graph. Of these, 49% consisted of one PT dose (primarily prescribed by ER and Medicine, 7/17 each.) Thirty percent of PT use was not streamlined with culture receipt (62% ICU, 27% medical, and 11% surgical.) Common reasons for “suboptimal” usage included: no need for gram negative/anaerobic or anti-pseudomonal coverage, need for blood brain barrier penetration. Clinical and microbiologic data, and hospital PT use trends will be presented.  See figure.

Conclusion:

Overall at least a third (given the broad interpretation of "appropriate" and “optimal” by local guidelines) of prescriptions would have benefited from a stewardship intervention –which would create an average of 8.7 PT assessments and 2.9 interventions per weekday for the duration of our study. One-time” nonconcordant use was common, possibly arising from a defensive approach to initially unclear clinical diagnoses . Other areas for improvement include using guidelines for empiric therapy, ordering pertinent cultures, and streamlining. These data demonstrate a need to develop a range of PT stewardship interventions in hospital settings.

 

Stephen Lee, MD, Department of Medicine, University of Alberta, Edmonton, AB, Canada, Michael Guirguis, BSc. Pharm, Ph.D, Pharmacy, University of Alberta Hospital, Edmonton, AB, Canada and Lynora Saxinger, MD, FRCPC, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada

Disclosures:

S. Lee, None

M. Guirguis, None

L. Saxinger, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.