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160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales
BACKGROUND: The reliability of piperacillin-tazobactam (TZP) and cefepime (FEP) breakpoints for extended spectrum β-lactamase Enterobacterales (ESBL-E) isolates remains controversial. The Infectious Diseases Society of America recommends against the use of TZP and FEP for the treatment of bloodstrea...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751900/ http://dx.doi.org/10.1093/ofid/ofac492.238 |
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author | O’Rourke, Emerald Binkley, Amanda Talati, Naasha J Patel, Sonal Maguire, Christina |
author_facet | O’Rourke, Emerald Binkley, Amanda Talati, Naasha J Patel, Sonal Maguire, Christina |
author_sort | O’Rourke, Emerald |
collection | PubMed |
description | BACKGROUND: The reliability of piperacillin-tazobactam (TZP) and cefepime (FEP) breakpoints for extended spectrum β-lactamase Enterobacterales (ESBL-E) isolates remains controversial. The Infectious Diseases Society of America recommends against the use of TZP and FEP for the treatment of bloodstream infections (BSIs) caused by ESBL-E, even when in-vitro susceptibility is demonstrated. The University of Pennsylvania Health System microbiology laboratory suppresses TZP susceptibilities on Escherichia coli and Klebsiella pneumoniae blood isolates nonsusceptible to ceftriaxone (CRO) or ceftazidime (CAZ) and specifies the presence of a multidrug resistant organism. However, FEP susceptibilities are reported. The objective of this study was to assess appropriate antimicrobial prescribing for the treatment of FEP-susceptible ESBL-E BSIs with our institution’s current susceptibility reporting practices. METHODS: This multicenter retrospective observational study included patients with blood cultures positive for E. coli, K. oxytoca, K. pneumoniae, and Proteus mirabilis nonsusceptible to CRO or CAZ but susceptible to FEP from August 1, 2018 through August 1, 2021. Patients with a concominant gram-negative infection or true beta-lactam allergy were excluded. Patients were assessed for appropriate therapy (demonstrated susceptibility to and administration of carbapenems fluoroquinolones, novel beta-lactam/beta-lactamase inhibitors, or sulfamethoxazole-trimethoprim) within 24 h following the availability of susceptibility results. RESULTS: During the study period 38 patients were included. Of the 38 patients, 52.6% (n=20) received appropriate therapy with an average time to appropriate therapy of 3.7 (SD 2.1) h. Among patients receiving inappropriate therapy (n=18), 50% (n=9) were changed to appropriate therapy >24 h after susceptibility results, with an average time to appropriate therapy of 46.5 (SD 44.4) h. The remaining 9 patients (23.7%) did not receive appropriate therapy beyond 24 h. CONCLUSION: Reporting FEP susceptibility results on ESBL-E blood isolates may contribute to the prescribing of FEP for the treatment of ESBL-E BSIs and delay appropriate antimicrobial therapy. Given these findings, cefepime will now be suppressed on ESBL-E blood isolates. DISCLOSURES: All Authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-9751900 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-97519002022-12-16 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales O’Rourke, Emerald Binkley, Amanda Talati, Naasha J Patel, Sonal Maguire, Christina Open Forum Infect Dis Abstracts BACKGROUND: The reliability of piperacillin-tazobactam (TZP) and cefepime (FEP) breakpoints for extended spectrum β-lactamase Enterobacterales (ESBL-E) isolates remains controversial. The Infectious Diseases Society of America recommends against the use of TZP and FEP for the treatment of bloodstream infections (BSIs) caused by ESBL-E, even when in-vitro susceptibility is demonstrated. The University of Pennsylvania Health System microbiology laboratory suppresses TZP susceptibilities on Escherichia coli and Klebsiella pneumoniae blood isolates nonsusceptible to ceftriaxone (CRO) or ceftazidime (CAZ) and specifies the presence of a multidrug resistant organism. However, FEP susceptibilities are reported. The objective of this study was to assess appropriate antimicrobial prescribing for the treatment of FEP-susceptible ESBL-E BSIs with our institution’s current susceptibility reporting practices. METHODS: This multicenter retrospective observational study included patients with blood cultures positive for E. coli, K. oxytoca, K. pneumoniae, and Proteus mirabilis nonsusceptible to CRO or CAZ but susceptible to FEP from August 1, 2018 through August 1, 2021. Patients with a concominant gram-negative infection or true beta-lactam allergy were excluded. Patients were assessed for appropriate therapy (demonstrated susceptibility to and administration of carbapenems fluoroquinolones, novel beta-lactam/beta-lactamase inhibitors, or sulfamethoxazole-trimethoprim) within 24 h following the availability of susceptibility results. RESULTS: During the study period 38 patients were included. Of the 38 patients, 52.6% (n=20) received appropriate therapy with an average time to appropriate therapy of 3.7 (SD 2.1) h. Among patients receiving inappropriate therapy (n=18), 50% (n=9) were changed to appropriate therapy >24 h after susceptibility results, with an average time to appropriate therapy of 46.5 (SD 44.4) h. The remaining 9 patients (23.7%) did not receive appropriate therapy beyond 24 h. CONCLUSION: Reporting FEP susceptibility results on ESBL-E blood isolates may contribute to the prescribing of FEP for the treatment of ESBL-E BSIs and delay appropriate antimicrobial therapy. Given these findings, cefepime will now be suppressed on ESBL-E blood isolates. DISCLOSURES: All Authors: No reported disclosures. Oxford University Press 2022-12-15 /pmc/articles/PMC9751900/ http://dx.doi.org/10.1093/ofid/ofac492.238 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Abstracts O’Rourke, Emerald Binkley, Amanda Talati, Naasha J Patel, Sonal Maguire, Christina 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title | 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title_full | 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title_fullStr | 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title_full_unstemmed | 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title_short | 160. Antimicrobial Prescribing Patterns in Bloodstream Infections Caused by Cefepime-Susceptible Extended Spectrum β-lactamase Enterobacterales |
title_sort | 160. antimicrobial prescribing patterns in bloodstream infections caused by cefepime-susceptible extended spectrum β-lactamase enterobacterales |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751900/ http://dx.doi.org/10.1093/ofid/ofac492.238 |
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