252. Relative use of carbapenems in immunocompromised patients
Session: Poster Abstract Session: Antimicrobial Stewardship: Special Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Relative use of carbapenems in immunocompromised patients.pdf (514.9 kB)
  • Background:

    Gram negative bacterial infections are associated with high mortality in immunocompromised hosts, and the presence of drug resistance further increases mortality.

    Antibiotic consumption is a key outcome measure for Antimicrobial Stewardship Programs. Proper utilization of antibiotics can help limit the development of antimicrobial resistance.

    Resistance in gram negative organisms such as Pseudomonas, Enterobacter, and Acinetobacter is a major issue given the paucity of new drugs in the antibiotic pipeline for these organisms.

    A novel relative carbapenem consumption metric (the Proportion of Carbapenem Consumption, or PoCC) was recently described in US academic medical centers. The PoCC is calculated as follows: PoCC = [(meropenem Days of therapy(DOT)/1000 Patient days (PDs))/ (meropenem DOT/1000 PDs + cefepime DOT/1000 PDs + piperacillin-tazobactam DOT/1000 PDs)]. The regional mean PoCC for the South Atlantic region has previously been approximated at 17%.

    Methods:

    We examined the PoCC for the Bone Marrow Transplant (BMT) and dedicated Hematology/Oncology (H/O) inpatient wards at an academic medical center from August 2012-June 2017.

    Results:

    Ward

    Piperacillin- tazobactam

    Cefepime

    Meropenem

    Total

    PoCC

    Hematology/ Oncology

    105.1

    134.4

    76.6

    316.1

    0.24

    Bone Marrow Transplant

    34.3

    201.0

    127.4

    362.7

    0.35

    National Means*

    76.2

    60.2

    30.7

    **

    0.18

    Table 1: Average use of antibiotics expressed in DOT/1000 PDs. *As described by Markley et al. Infect Control Hosp Epidemiol 2018;39:229-232. **Data unavailable.

     

    Conclusion:

    This is the first description of the PoCC metric for dedicated Hematology/Oncology and Bone Marrow Transplant wards. When compared to national and regional mean PoCC scores for academic medical centers, the PoCC for these units was higher. More research is needed to determine the optimal PoCC scores for these types of units.

    The PoCC can contextualize relative carbapenem use and may be a useful antibiotic consumption metric. However, it does not provide data on absolute consumption.

    Further studies are needed to determine the best use of the PoCC metric by Antimicrobial Stewardship Programs for Hematology/Oncology and Bone Marrow Transplant wards.

     

    Jacob Pierce, MD1, Kimberly Lee, PharmD2, John Markley, DO3, Amy Pakyz, PharmD, MS, PhD4, Michelle Doll, MD, MPH5, Andrew Kirk, BS6, Gonzalo Bearman, MD, MPH, FSHEA7, Oveimar De La Cruz, MD3 and Michael Stevens, MD, MPH3, (1)Internal Medicine, VCU Commonwealth Health System, Richmond, VA, (2)Virginia Commonwealth University Health System, Richmond, VA, (3)Infectious Diseases, Virginia Commonwealth University Health System, Richmond, VA, (4)Dept. of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA, (5)VCU Medical Center, Richmond, VA, (6)Virginia Commonwealth University School of Medicine, Richmond, VA, (7)Infectious Diseases, VCU Medical Center, Richmond, VA

    Disclosures:

    J. Pierce, None

    K. Lee, None

    J. Markley, None

    A. Pakyz, None

    M. Doll, None

    A. Kirk, None

    G. Bearman, None

    O. De La Cruz, None

    M. Stevens, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.