Introduction:

The national supply problems of piperacillin/tazobactam began in 2017, but it was in 2018 when our center suffered severe shortage problems. The objective is to know the impact of the evaluation of the indication of piperacillin-tazobactam in the framework of the Antimicrobial Stewardship Program (ASP) during the shortage period of 2018.

Methods:

The interventions carried out by the ASP were analyzed prospectively. Were collected: demographic and clinical variables, previous antibiotherapy, background, recommendation made, acceptance, cure, mortality attributable to the infection and gross mortality at 30 days. Likewise, the impact on consumption and cost of piperacillin-tazobactam and carbapenems was evaluated. We compared the cases that evolved to clinical cure and mortality, among patients whose physicians accepted or rejected the recommendation for modification.

Results:

181 recommendations were made (126 patients), the treatment was adequate in 53.6%, 28.2% de-escalation, 8.8% suspension, 5.5% dose adjustment and 2.2% escalation. Overall acceptance was 91.6%. The most recommended antibiotics were cephalosporins with or without anaerobicide (60%).

The clinical cure was 85%, the gross mortality 21% and the attributable 8.7%. No differences were found in clinical cure (p=0.068) and mortality (p=0.68) among those who accepted and rejected the recommendations. The consumption of piperacillin-tazobactam was reduced by 58.6%, with an estimated saving of 204,299 euros. The consumption of carbapenems was increased by 6.1%.

Conclusion:

ASP intervention on the prescription of piperacillin-tazobactam has been mostly accepted, efficient, neutral in clinical outcomes and has prevented displacement to carbapenems.

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