The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Clostridium difficile Risk in 88 US Medical Centers

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Gross, Alan E. ; Johannes, Richard S. ; Gupta, Vikas ; Tabak, Ying P. ; Srinivasan, Arjun ; Bleasdale, Susan C.
• Description:
  Background.
  
  Anti-infective shortages are a pervasive problem in the United States. The objective of this study was to identify any associations between changes in prescribing of antibiotics that have a high risk for CDI during a piperacillin/tazobactam (PIP/TAZO) shortage and hospital-onset Clostridium difficile infection (HO-CDI) risk in 88 US medical centers.
  
  Methods.
  
  We analyzed electronically captured microbiology and antibiotic use data from a network of US hospitals from July 2014 through June 2016. The primary outcome was HO-CDI rate and the secondary outcome was changes in antibiotic usage. We fit a Poisson model to estimate the risk of HO-CDI associated with PIP/TAZO shortage that were associated with increased high-risk antibiotic use while controlling for hospital characteristics.
  
  Results.
  
  A total of 88 hospitals experienced PIP/TAZO shortage and 72 of them experienced a shift toward increased use of high-risk antibiotics during the shortage period. The adjusted relative risk (RR) of HO-CDI for hospitals experiencing a PIP/TAZO shortage was 1.03 (95% confidence interval [CI], .85–1.26; P = .73). The adjusted RR of HO-CDI for hospitals that both experienced a shortage and also showed a shift toward increased use of high-risk antibiotics was 1.30 (95% CI, 1.03–1.64; P < .05).
  
  Conclusions.
  
  Hospitals that experienced a PIP/TAZO shortage and responded to that shortage by shifting antibiotic usage toward antibiotics traditionally known to place patients at greater risk for CDI experienced greater HO-CDI rates; this highlights an important adverse effect of the PIP/TAZO shortage and the importance of antibiotic stewardship when mitigating drug shortages.
  
  
• Subjects:
  Anti-Bacterial Agents Clostridioides Difficile Clostridium Infections Drug Prescriptions Humans Penicillanic Acid Piperacillin Piperacillin, Tazobactam Drug Combination Treatment Outcome United States
• Keywords:
  Clostridium Difficile Drug Shortage Piperacillin/Tazobactam
• Source:
  Clin Infect Dis. 65(4):613-618
• Pubmed ID:
  28444166
• Pubmed Central ID:
  PMC11320714
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  65
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:03b71dfb7ec44b1529b8a4095277e7fe8cae914fe5f5fbaa63090b7d8ae3a7ebbd1ba89e19e78d86bd71edc751755443b597f6efb50781880c172820bdf5d6b7
• Download URL:
  https://stacks.cdc.gov/view/cdc/159839/cdc_159839_DS1.pdf
• File Type:
  [PDF - 489.59 KB ]