Abstract
Background
Current cIAI guidelines recommend that broad-spectrum antibiotics (abs) like anti-pseudomonal β-lactams should be reserved for “high-risk” CO cIAI patients. Fluoroquinolone (FQ) use is also discouraged in geographic areas with a high incidence of FQ-resistance. Compliance with these recommendations are unclear as there are limited data on empiric treatment (tx) patterns for adult patients with cIAI across US hospitals. This study sought to evaluate empiric tx patterns for patients with CO LR cIAI and assess compliance with cIAI guideline recommendations.
Methods
A retrospective multi-center study using data from the Premier Research Database (October 2015–December 2017) was performed. Inclusion criteria: age ≥ 18 years; hospitalized; primary cIAI diagnosis and a cIAI surgical procedure or a secondary cIAI diagnosis and cIAI surgical procedure within 5 days of admission; and received an ab within first 4 hospital days. For patients with multiple cIAI admissions, only the first cIAI was considered. Apt was classified as high-risk (HR) if they met any one of the following criteria: sepsis, severe sepsis, septic shock; ≥3 components of sepsis; or ≥2 two physiologic risk factors (age ≥ 70 years, malignancy, kidney dysfunction, hepatic dysfunction, hypoalbuminemia, and significant cardiovascular compromise). Empiric tx was abs received during the first 4 hospital days. Incidence of empiric tx regimen including one of the following abs was determined among LR patients: piperacillin/tazobactam (TZP), meropenem (MER), cefepime (CFP), and FQ.
Results
Overall, 70,275 patients met study criteria; 11,382 (16%) were HR and 58,893 (84%) were LR. Among LR CO cIAI patients, the mean (SD) age was 54.3 (18.1), 52% were male, and the median (IQR) for Charlson Comorbidity Index was 0 (0–1). The most common diagnosis among LR patients was acute appendicitis with peritonitis (53%). The 10 most common empiric antibiotics administered are shown in table. Among LR patients, 52% received TZP, 3% received MER, 3% received CFP, and 20% received a FQ; 8% received ≥2 of these agents.
Conclusion
Overuse of non-guideline concordant broad-spectrum abs was commonplace among CO cIAI patients classified as LR. These findings can serve as the basis for an antimicrobial stewardship initiative in hospitals aspiring to reduce the use of broad-spectrum antibiotics.
Disclosures
All authors: No reported disclosures.
A Decision Tree Using Patient Characteristics to Predict Resistance to Commonly Used Broad-Spectrum Antibiotics in Children With Gram-Negative Bloodstream Infections