Sanaa Saeed Mekdad1, Leenah AlSayed2. 1. Department of Clinical Pharmacy, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Saudi Arabia. smekdad@kfmc.med.sa. 2. Department of In-patient Pharmacy, King Fahad Medical City, Riyadh, 11525, Saudi Arabia.
Abstract
BACKGROUND: The appropriate use of Piperacillin/Tazobactam (Pip/Taz), including the correct dose, escalating and or de-escalation according to the microbiological culture is essential to reduce the antibiotic resistance. Resistant to antimicrobials in a major global problem and contributes significantly to morbidity, mortality and cost of care. Guidelines exists to ensure appropriate use of Pip/Taz. Antibiotics Stewardship guidelines (https://apps.who.int/iris/bitstream/handle/10665/329404/9789241515481-eng.pdf) provides a detailed recommendation with regards to initiation, monitoring and escalation and de-escalation based on final culture results. Appling such guidelines ensures a more proper utilization of the empiric uses of antibiotics used in the hospital-based setting. Use of Pip/Taz in cases of suspected infection postoperatively is common practice in the cardiac surgery ward where this study was conducted. METHODS: This was a prospective cohort study involving all patients who were admitted to the cardiac surgery unit of a tertiary care center. All patient prescribed at least 1 day of Pip/Taz as an empirical therapy were included and prospectively observed. We aimed to evaluate the use of Pip/Taz and its appropriateness based on Antibiotics Stewardship guidelines (ASG). Any deviation from the guidelines in initiation, escalation, de-escalation based on culture and sensitivity results was considered inappropriate use. Four patients died (1.3%) early as result of complications for surgery but included in the analysis. The study was conducted from October 2017 to October 2018. RESULTS: Of the 300 patients who received Pip/Taz Cultures were done in 250 patients (83%). The overall appropriate use of Pip/Taz was seen in 166 patients (55.3%). CONCLUSION: The empirical use of Pip/Taz in the surgical cardiac unit was largely inappropriate and not entirely driven by the culture test results. Interventions are needed to optimize the use of Pip/Taz including appropriate culture and sensitivity driven use and timely de-escalation or de-escalation when indicated. This will prevent emergence of resistance and reduce the patient toxicity and financial costs.
BACKGROUND: The appropriate use of Piperacillin/Tazobactam (Pip/Taz), including the correct dose, escalating and or de-escalation according to the microbiological culture is essential to reduce the antibiotic resistance. Resistant to antimicrobials in a major global problem and contributes significantly to morbidity, mortality and cost of care. Guidelines exists to ensure appropriate use of Pip/Taz. Antibiotics Stewardship guidelines (https://apps.who.int/iris/bitstream/handle/10665/329404/9789241515481-eng.pdf) provides a detailed recommendation with regards to initiation, monitoring and escalation and de-escalation based on final culture results. Appling such guidelines ensures a more proper utilization of the empiric uses of antibiotics used in the hospital-based setting. Use of Pip/Taz in cases of suspected infection postoperatively is common practice in the cardiac surgery ward where this study was conducted. METHODS: This was a prospective cohort study involving all patients who were admitted to the cardiac surgery unit of a tertiary care center. All patient prescribed at least 1 day of Pip/Taz as an empirical therapy were included and prospectively observed. We aimed to evaluate the use of Pip/Taz and its appropriateness based on Antibiotics Stewardship guidelines (ASG). Any deviation from the guidelines in initiation, escalation, de-escalation based on culture and sensitivity results was considered inappropriate use. Four patientsdied (1.3%) early as result of complications for surgery but included in the analysis. The study was conducted from October 2017 to October 2018. RESULTS: Of the 300 patients who received Pip/Taz Cultures were done in 250 patients (83%). The overall appropriate use of Pip/Taz was seen in 166 patients (55.3%). CONCLUSION: The empirical use of Pip/Taz in the surgical cardiac unit was largely inappropriate and not entirely driven by the culture test results. Interventions are needed to optimize the use of Pip/Taz including appropriate culture and sensitivity driven use and timely de-escalation or de-escalation when indicated. This will prevent emergence of resistance and reduce the patienttoxicity and financial costs.
Entities:
Keywords:
Antibiotic stewardship program, De-escalation of antibiotics; Drug utilization review; Piperacillin-Tazobactam; Rational use of pip/Taz
Authors: D M Livermore; S Mushtaq; D James; N Potz; R A Walker; A Charlett; F Warburton; A P Johnson; M Warner; C J Henwood Journal: Int J Antimicrob Agents Date: 2003-07 Impact factor: 5.283
Authors: B Ostrowsky; R Ruiz; S Brown; P Chung; E Koppelman; C van Deusen Lukas; Y Guo; H Jalon; Z Sumer; C Araujo; I Sirtalan; C Brown; P Riska; B Currie Journal: Infect Control Hosp Epidemiol Date: 2014-10 Impact factor: 3.254