TY - JOUR
T1 - Pharmacoepidemiology of Ceftazidime-Avibactam Use
T2 - A Retrospective Cohort Analysis of 210 US Hospitals
AU - Strich, Jeffrey R.
AU - Ricotta, Emily
AU - Warner, Sarah
AU - Lai, Yi Ling
AU - Demirkale, Cumhur Y.
AU - Hohmann, Samuel F.
AU - Rhee, Chanu
AU - Klompas, Michael
AU - Palmore, Tara
AU - Powers, John H.
AU - Dekker, John P.
AU - Adjemian, Jennifer
AU - Matsouaka, Roland
AU - Woods, Christopher W.
AU - Danner, Robert L.
AU - Kadri, Sameer S.
N1 - Publisher Copyright:
© 2020 Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2021/2/15
Y1 - 2021/2/15
N2 - Background: Ceftazidime-avibactam has in vitro activity against some carbapenem-resistant gram-negative infections (GNIs), and therefore may be a useful alternative to more toxic antibiotics such as colistin. Understanding ceftazidime-avibactam uptake and usage patterns would inform hospitalformularies, stewardship, and antibiotic development. Methods: A retrospective cohort study assessed inpatient encounters in the Vizient database. Ceftazidime-avibactam and colistin administrations were categorized into presumed empiric (3 consecutive days of therapy or less with qualifying exclusions) versus targeted therapy (≥4 consecutive days of therapy) for presumed carbapenem-resistant GNIs. Quarterly percentage change (QPC) using modified Poisson regression and relative change in frequency of targeted ceftazidime-avibactam to colistin encounters was calculated. Factors associated with preferentially receiving targeted ceftazidime-avibactam versus colistin were identified using generalized estimating equations. Results: Between 2015 quarter (q) 1 and 2017q4, ceftazidime-avibactam was administered 21 215 times across 1901 encounters. Inpatient prescriptions for ceftazidime-avibactam increased from 0.44/10 000 hospitalizations in 2015q1 to 7.7/10 000 in 2017q4 (QPC, +11%; 95% CI, 10-13%; P <. 01), while conversely colistin prescriptions decreased quarterly by 5% (95% CI, 4-6%; P <. 01). Ceftazidime-avibactam therapy was categorized as empiric 25% of the time, targeted 65% of the time, and indeterminate 10% of the time. Patients with chronic kidney disease were twice as likely to receive targeted ceftazidime-avibactam versus colistin (RR, 2.02; 95% CI, 1.82-2.25), whereas those on dialysis were less likely to receive ceftazidime-avibactam than colistin (RR, 0.71; 95% CI,. 61-.83). Conclusions: Since approval in 2015, ceftazidime-avibactam use has grown for presumed carbapenem-resistant GNIs, while colistin has correspondingly declined. Renal function drove the choice between ceftazidime-avibactam and colistin as targeted therapy.
AB - Background: Ceftazidime-avibactam has in vitro activity against some carbapenem-resistant gram-negative infections (GNIs), and therefore may be a useful alternative to more toxic antibiotics such as colistin. Understanding ceftazidime-avibactam uptake and usage patterns would inform hospitalformularies, stewardship, and antibiotic development. Methods: A retrospective cohort study assessed inpatient encounters in the Vizient database. Ceftazidime-avibactam and colistin administrations were categorized into presumed empiric (3 consecutive days of therapy or less with qualifying exclusions) versus targeted therapy (≥4 consecutive days of therapy) for presumed carbapenem-resistant GNIs. Quarterly percentage change (QPC) using modified Poisson regression and relative change in frequency of targeted ceftazidime-avibactam to colistin encounters was calculated. Factors associated with preferentially receiving targeted ceftazidime-avibactam versus colistin were identified using generalized estimating equations. Results: Between 2015 quarter (q) 1 and 2017q4, ceftazidime-avibactam was administered 21 215 times across 1901 encounters. Inpatient prescriptions for ceftazidime-avibactam increased from 0.44/10 000 hospitalizations in 2015q1 to 7.7/10 000 in 2017q4 (QPC, +11%; 95% CI, 10-13%; P <. 01), while conversely colistin prescriptions decreased quarterly by 5% (95% CI, 4-6%; P <. 01). Ceftazidime-avibactam therapy was categorized as empiric 25% of the time, targeted 65% of the time, and indeterminate 10% of the time. Patients with chronic kidney disease were twice as likely to receive targeted ceftazidime-avibactam versus colistin (RR, 2.02; 95% CI, 1.82-2.25), whereas those on dialysis were less likely to receive ceftazidime-avibactam than colistin (RR, 0.71; 95% CI,. 61-.83). Conclusions: Since approval in 2015, ceftazidime-avibactam use has grown for presumed carbapenem-resistant GNIs, while colistin has correspondingly declined. Renal function drove the choice between ceftazidime-avibactam and colistin as targeted therapy.
KW - carbapenem resistance
KW - ceftazidime-avibactam
KW - novel beta-lactamase inhibitors
KW - ram-negative resistance
UR - http://www.scopus.com/inward/record.url?scp=85102153733&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa061
DO - 10.1093/cid/ciaa061
M3 - Article
C2 - 32107536
AN - SCOPUS:85102153733
SN - 1058-4838
VL - 72
SP - 611
EP - 621
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -