Impact of a Piperacillin-Tazobactam Shortage on Antimicrobial Prescribing and the Rate of Vancomycin-Resistant Enterococci and Clostridium difficile Infections

Authors

  • Dr. Marisa N. Mendez Pharm.D.,

    1. Department of Clinical Pharmacy, School of Pharmacy School of Medicine, University of California–San Francisco
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  • Laurel Gibbs B.S.,

    1. Department of Hospital Epidemiology and Infection Control, University of California–San Francisco Medical Center San Francisco, California.
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  • Dr. Richard A. Jacobs M.D., Ph.D.,

    1. Division of Infectious Diseases, Department of Medicine School of Medicine, University of California–San Francisco
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  • Dr. Charles E. McCulloch Ph.D.,

    1. Department of Epidemiology and Biostatistics School of Medicine, University of California–San Francisco
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  • Dr. Lisa Winston M.D.,

    1. Division of Infectious Diseases, Department of Medicine School of Medicine, University of California–San Francisco
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  • Dr. B. Joseph Guglielmo Pharm.D.

    Corresponding author
    1. Department of Clinical Pharmacy, School of Pharmacy School of Medicine, University of California–San Francisco
      Department of Clinical Pharmacy C152, 521 Parnassus Avenue, University of California–San Francisco, San Francisco, CA 94143–0622; e-mail: guglielmoj@pharmacy.ucsf.edu.
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Department of Clinical Pharmacy C152, 521 Parnassus Avenue, University of California–San Francisco, San Francisco, CA 94143–0622; e-mail: guglielmoj@pharmacy.ucsf.edu.

Abstract

Study Objective. To evaluate the impact of a shortage of piperacillintazobactam in the United States in 2002 on antimicrobial prescribing and associated rates of vancomycin-resistant enterococci (VRE) and Clostridium difficile infections.

Design. Retrospective chart review.

Setting. University-affiliated medical center.

Measurements and Main Results. Microbiologic reports, patient demographics, and antimicrobial utilization were evaluated for patients admitted 6 months before the shortage (March 1-August 31, 2001) and for 6 months during the shortage (March 1-August 31, 2002). Significant increases in usage of alternative β-lactamase inhibitor combinations, cefepime, levofloxacin, vancomycin, clindamycin, and metronidazole were observed during the shortage; in contrast, a significant decrease in the use of ceftriaxone took place. No change in the rate of VRE infection was observed from before to during the piperacillin-tazobactam shortage. However, a paradoxical 47% decrease in the rate of C. difficile colitis was documented during the shortage. Subsequent multivariate analyses suggested the reduced use of ceftriaxone and increased use of levofloxacin, but not the reduced use of piperacillin-tazobactam, correlated with the decreased rate of C. difficile infections.

Conclusion. The piperacillin-tazobactam shortage was associated with significant changes in antimicrobial prescribing, which resulted in a significant reduction in the rate of C. difficile but not VRE infections.

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