哌拉西林/他唑巴坦短缺前后抗菌药物使用和感染率的变化。
Shifts in antimicrobial consumption and infection rates before and during a piperacillin/tazobactam shortage.
机构信息
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS 39216, USA; Department of Medicine-Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS 39216, USA.
出版信息
J Glob Antimicrob Resist. 2017 Dec;11:111-113. doi: 10.1016/j.jgar.2017.07.015. Epub 2017 Jul 31.
OBJECTIVES
Anti-infective shortages represent a growing threat to optimum management of infected patients and alter the institutional selective pressure against hospital-acquired infections (HAIs). The objective of this analysis was to assess the impact of a shortage of piperacillin/tazobactam (TZP) on overall antibacterial use and HAI rates at an academic institution.
METHODS
Antimicrobial use and infection data were extracted from TheraDoc Clinical Surveillance Software (Premier, Inc.) for adult patients and were stratified as pre-shortage (October-December 2014) and post-shortage (February-April 2015). Paediatric and emergency department use were excluded. Antimicrobial use was reported as percent change and defined daily doses (DDD)/1000 patient-days (PD). Pre- and post-shortage vancomycin-resistant enterococci (VRE) and Clostridium difficile-associated diarrhoea (CDAD) rates were normalised to 1000 PD/month.
RESULTS
Total use of target antimicrobials remained constant before and after TZP shortage (990.29 vs. 957.77). Total TZP use fell 95.2% (81.1 vs. 3.9). Total meropenem use rose 96.0% (42.3 vs. 82.9) after the shortage, driven by a 125.4% increase in use for non-ICU patients. Cefepime and ceftazidime use rose 97.9% (28.2 vs. 55.8) and 94.2% (1.6 vs 3.0), respectively. Cefepime use in non-ICU patients rose 223.2%. Fluoroquinolone consumption did not differ between periods. CDAD rates decreased (-21.8%), whilst VRE rates doubled during the shortage (0.6 vs. 1.3 infections/1000 PD/month).
CONCLUSIONS
Whilst overall antimicrobial use appeared steady, the TZP shortage resulted in increased use of multiple other antimicrobials. The doubling of VRE rates is concerning and illustrates the need for increased antimicrobial stewardship vigilance and education in response to shifting prescribing patterns during shortages.
目的
抗感染药物短缺对感染患者的最佳治疗构成了日益严重的威胁，并改变了医疗机构对抗医院获得性感染（HAI）的选择性压力。本分析的目的是评估学术机构中哌拉西林/他唑巴坦（TZP）短缺对整体抗菌药物使用和 HAI 发生率的影响。
方法
从 TheraDoc 临床监测软件（Premier，Inc.）中提取成人患者的抗菌药物使用和感染数据，并分为短缺前（2014 年 10 月至 12 月）和短缺后（2015 年 2 月至 4 月）两个阶段。排除儿科和急诊科的使用数据。抗菌药物使用以百分比变化和定义日剂量（DDD）/1000 患者日（PD）表示。将短缺前和短缺后万古霉素耐药肠球菌（VRE）和艰难梭菌相关性腹泻（CDAD）的发生率归一化为 1000 PD/月。
结果
TZP 短缺前后目标抗菌药物的总使用量保持不变（990.29 比 957.77）。TZP 的总用量下降了 95.2%（81.1 比 3.9）。短缺后，美罗培南的总用量增加了 96.0%（42.3 比 82.9），主要是由于非 ICU 患者的用量增加了 125.4%。头孢吡肟和头孢他啶的用量分别增加了 97.9%（28.2 比 55.8）和 94.2%（1.6 比 3.0）。非 ICU 患者的头孢吡肟用量增加了 223.2%。氟喹诺酮类药物的使用在两个时期之间没有差异。CDAD 发生率下降（-21.8%），而 VRE 发生率在短缺期间翻了一番（0.6 比 1.3 感染/1000 PD/月）。
结论
尽管总体抗菌药物使用似乎保持稳定，但 TZP 短缺导致其他多种抗菌药物的使用增加。VRE 发生率翻了一番令人担忧，这表明需要加强抗菌药物管理的警惕性和教育，以应对短缺期间处方模式的变化。
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