Piperacillin-tazobactam (TZP) is frequently used for intra-abdominal infection (IAI). Our institution experienced consecutive shortages of TZP and cefepime, providing an opportunity to review prescribing patterns and microbiology for IAI. Hospitalized adult patients treated for IAI, based on prescriber selection of IAI as the indication within the antibiotic order, between March 2014 and February 2018 were identified from the University of Virginia Clinical Data Repository and Infection Prevention and Control Database. Antimicrobial utilization, microbiologic data, and clinical outcomes were compared across four 1-year periods: preshortage, TZP shortage, cefepime shortage, and postshortage. There were 7,668 episodes of antimicrobial prescribing for an indication of IAI during the study period. Cefepime use for IAI increased 190% during the TZP shortage; meanwhile ceftriaxone use increased by only 57%. There was no increase in in-house mortality, colonization with resistant organisms, or Clostridioides difficile infection among patients treated with IAI during the shortage periods. Among a subset of cases randomly selected for review, Pseudomonas sp. was a rare cause of IAI, but antipseudomonal antibiotics were commonly prescribed empirically. We observed a large increase in cefepime utilization for IAI during a TZP shortage that was not warranted based on the observed frequency of identification of Pseudomonas sp. as the causative organism in IAI, suggesting a need to revisit national guideline recommendations.

中文翻译：

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连续的抗生素短缺凸显了微生物学与腹内感染处方实践之间的差异


哌拉西林-他唑巴坦 (TZP) 经常用于治疗腹内感染 (IAI)。我们的机构经历了 TZP 和头孢吡肟的连续短缺，这为审查 IAI 的处方模式和微生物学提供了机会。根据弗吉尼亚大学临床数据存储库和感染预防和控制数据库，确定了 2014 年 3 月至 2018 年 2 月期间接受 IAI 治疗的住院成人患者，这些患者是根据处方者选择 IAI 作为抗生素处方中的适应症而确定的。比较了四个一年期的抗菌药物使用、微生物学数据和临床结果：短缺前、TZP 短缺、头孢吡肟短缺和短缺后。研究期间，有 7,668 次因 IAI 指征而开出抗菌药物处方。在 TZP 短缺期间，头孢吡肟用于 IAI 的使用量增加了 190%；与此同时，头孢曲松的使用量仅增加了 57%。在短缺期间接受 IAI 治疗的患者中，内部死亡率、耐药微生物定植或艰难梭菌感染没有增加。在随机选择进行审查的一组病例中，假单胞菌属sp。是 IAI 的罕见原因，但抗假单胞菌抗生素通常是根据经验开出的。我们观察到，在 TZP 短缺期间，头孢吡肟用于 IAI 的利用率大幅增加，根据观察到的假单胞菌鉴定频率，这是不合理的。作为 IAI 的致病微生物，表明有必要重新审视国家指南建议。