A Vitamin T Overdose? : An audit of piperacillin/ tazobactam use at
Download
Report
Transcript A Vitamin T Overdose? : An audit of piperacillin/ tazobactam use at
+
A Vitamin T Overdose? : An audit of piperacillin/
tazobactam use at Royal Perth Hospital
Amelia Davis and Matthew Hanson
Contributors: Dr Susan Benson, Dr Owen Robinson, Matthew Rawlins
+
Background
Piperacillin/ tazobactam (commonly: Tazocin)
4g + 0.5g tds
B lactam + B lactamase inhibitor
Broad spectrum: gram positive, gram negative* and anaerobes*
Largely replaced ticarcillin/clavulanate (Timentin) in 2010
“Unrestricted”
+
Introduction
Restrictions for other antibiotics:
Broad spectrum cephalosporins
Carbapenems
Glycopeptides
Flouroquinolones
Others
Lack of specific guidelines or restrictions for piperacillin/
tazobactam
+
Purpose
Review the indications and appropriateness of piperacillin/
tazobactam
Attempt to highlight hospital specific factors influencing
prescribing
+
Methods
A cross sectional, point prevalence study
National Antimicrobial Prescribing Survey
571 inpatients at Royal Perth Hospital on 14/11/12
To quantify and analyse the use of antimicrobials
Identified patients on piperacillin/ tazobactam (n=78)
Recalled patient notes
Recorded indication for antibiotic, diagnosis, frequency of
administration and prescribing department
All non-concordant prescriptions reviewed by two ID
Physicians
+
Methods
Category
C- Concordant with guidelines
NC(A)- Non- concordant with guidelines but deemed
Appropriate by ID review
NC (IA) – Non- concordant with guidelines (Inappropriate
choice)
F- Correct Choice but incorrect frequency
Where C= Concordant with therapeutic
guidelines or RPH guidelines
+
Results
Overall
Category
Number of Patients
(n=78)
C- Concordant with guidelines
25 (32%)
NC(A)- Non- concordant with
guidelines but deemed
Appropriate by ID review
19 (24%)
NC (IA) – Non- concordant with
guidelines (Inappropriate choice)
34 (44%)
F- Correct Choice but incorrect
frequency
4 (5%)
+
Results
Category C – Concordant with guidelines
Indication
Peritonitis
Diabetic Ulcer
Contaminated Wound
Animal/Human Bite
Aspiration Pneumonia
HAP – high risk
Febrile Neutropaenia
Necrotising Pancreatitis
Number (n=25)
9
4
3
3
3
1
1
1
+
Results
Category NC(A) – Not concordant with
guidelines but deemed an appropriate
choice by ID Physicians
Indication
Abdominal infections
Skin infections
Respiratory infections
Urinary tract infections
Abdominal infections included:
• appendicitis
• cholecystitis
• abscess
• fistulae
• bowel necrosis
• non-specific infective surgical abdomen
Number (n=19)
12
3
2
2
+
Results
Category NC(IA) – Not concordant with
guidelines – inappropriate choice
Indication
Poor antibiotic
reasoning (47%)
No indication for antibiotic
“Febrile Neutropaenia” (not
meeting criteria for
neutropaenia)
Prolonged post-surgical
prophylaxis
Unnecessary broad CAP
spectrum of action Empirical UTI
(53%)
Cellulitis
Wound infection – without
systemic symptoms
Number
(n=34)
11
3
2
6
4
2
2
+
Breakdown by department
Appropriate
Not
Appropriate
Medical
12
20
Surgical
32
14
Chi- squared test
P= 0.0049
Statistically significant difference between medical and surgical
teams
+
Frequency/Dose
Frequency
3 incidences of bi- daily dosing
1 incidence of alternate day dosing
All documented to be due to “renal impairment”
None actually met criteria for reduced dosing (GFR <20ml/min)
Dosing
All 78 prescriptions 4 + 0.5g
+
Limitations
Cross sectional, retrospective study
Sample size
Poor documentation
Did not formally analyse duration of therapy
+
Conclusions
What we do well
Piperacillin/ tazobactam was appropriate in 56%
Common appropriate indications:
Peritonitis
Diabetic ulcers
What we don’t do so well
Piperacillin/ tazobactam was inappropriate in 44%
Poor antibiotic reasoning
Unnecessary use of broad spectrum
Documentation
+
Further Questions Raised?
Why are we prescribing inappropriately?
Over treating?
Medical vs Surgical?
Restricted use of other antibiotics?
Concern about risk of toxicity with aminoglycosides use?
What do we do now?
Education re: common inappropriate uses
Improve documentation
+
Questions?