2398. Utilization Practices of Ceftazidime-avibactam at Academic Medical Centers in the United States
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall

Background: Ceftazidime-avibactam (CAV) was US FDA-approved for complicated intra-abdominal/urinary tract infections in 2015, and for hospital-acquired/ventilator-associated pneumonia in 2018. However, little is known about its real-world use.

                         

Methods: Encounters of inpatients receiving CAV at academic hospitals in the VizientTM Clinical Resource Manager were identified (CAV encounters). CAV administered for ≤2 consecutive days during an encounter or any duration of CAV within 2 days of admission (excluding acute care hospital transfers) was considered empiric therapy. Targeted therapy was defined as ≥4 consecutive days or death within 2 days of therapy; empiric and targeted therapy cohorts were mutually inclusive. CAV-encounter characteristics, use patterns and Infectious Disease (ID) consultation were examined. Quarterly hospital uptake of CAV and % change in CAV encounter prevalence (using Poisson regression) were calculated.

Results: From January 2015 to December 2017, 20,590 CAV doses occurred in 2,128 encounters among 1,652 patients. Mean duration of therapy was 8 ± 7.9 days (range 1-86); overall mortality was 24%. The number of hospitals prescribing CAV increased from 5 to 92/168 and quarterly prevalence of CAV encounters increased from 5/10,000 hospitalizations in 2015q1 to 9.8 in 2017q4 (% change=2.1[0.7-3.6] %/quarter; (p=0.004).  Therapy was empiric in 904 (42%) encounters and targeted in 1,472 (69%); 63% of empiric CAV was initiated within 2 days of admission. CAV was initiated in the ICU in 862 (40.5%) encounters. Infection site was coded as respiratory in 34%, urinary in 26% and abdominal in 16% of encounters. Within 31 hospitals reporting consultant specialty, 29% of targeted therapy occurred without ID consultation. For targeted therapy encounters, CAV monotherapy occurred in 841 (57%) and combination therapy in 631 (43%) encounters, which most often included aminoglycosides, colistin or tigecycline. Mortality was 22% in the monotherapy and 25% in the combination therapy group (p=0.08).

Conclusion: CAV use across US academic medical centers has increased modestly over 3 years. More than 40% of CAV prescriptions appear to be empiric and targeted therapy often occurs without ID consultation at academic centers.

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Jeffrey R. Strich, MD1,2, Emily Ricotta, PhD, ScM3, Yi Ling Lai, MPH3, Samuel Hohmann, PhD4,5, Sadia Hussain, MD1, Chanu Rhee, MD, MPH6,7, Michael Klompas, MD, MPH, FRCPC, FIDSA6,7, Tara N. Palmore, M.D.8, John H. Powers III, MD9, John P. Dekker, M.D., Ph.D.10, Jennifer Adjemian, PhD2,3, Robert L. Danner, MD1, Sameer S. Kadri, MD, MS1 and NIH Antimicrobial Resistance Outcomes Research Initiative (ARORI), (1)Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, (2)United States Public Health Service, Commissioned Corps, Rockville, MD, (3)Epidemiology Unit, Division of Intramural Research, NIAID, NIH, Bethesda, MD, (4)Center for Advanced Analytics, Vizient, Chicago, IL, (5)Department of Health Systems Management, Rush University, Chicago, IL, (6)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (7)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, (8)Hospital Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD, (9)Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick, MD, (10)Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, MD

Disclosures:

J. R. Strich, None

E. Ricotta, None

Y. L. Lai, None

S. Hohmann, None

S. Hussain, None

C. Rhee, None

M. Klompas, None

T. N. Palmore, None

J. H. Powers III, None

J. P. Dekker, None

J. Adjemian, None

R. L. Danner, None

S. S. Kadri, None

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