title: Impact of a piperacillin-tazobactam shortage on antimicrobial prescribing and the rate of vancomycin-resistant enterococci and Clostridium difficile infections.
abstract: States in 2002 on antimicrobial prescribing and associated rates of vancomycin-resistant enterococci (VRE) and Clostridium difficile infections.Design. Retrospective chart review.Setting. University-affiliated medical center. Measurements and Main Results. Microbiologic reports, patient demographics, and antimicrobial utilization were evaluated for patients admitted 6 months before the shortage (March 1-August 31, 2001) and for 6 months during the shortage (March 1-August 31, 2002). Significant increases in usage of alternative mu-lactamase inhibitor combinations, cefepime, levofloxacin, vancomycin, clindamycin, and metronidazole were observed during the shortage; in contrast, a significant decrease in the use of ceftriaxone took place. No change in the rate of VRE infection was observed from before to during the piperacillin-tazobactam shortage. However, a paradoxical 47% decrease in the rate of C. difficile colitis was documented during the shortage. Subsequent multivariate analyses suggested the reduced use of ceftriaxone and increased use of levofloxacin, but not the reduced use of piperacillin-tazobactam, correlated with the decreased rate of C. difficile infections.
  
  
  CONCLUSIONS
  The piperacillin-tazobactam shortage was associated with significant changes in antimicrobial prescribing, which resulted in a significant reduction in the rate of C. difficile but not VRE infections.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, School of Medicine, University of California--San Francisco, San Francisco, California 94143, USA.
authors.forename: Marisa N
authors.initials: MN
authors.lastname: Mendez
authors.forename: Laurel
authors.initials: L
authors.lastname: Gibbs
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jacobs
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Lisa
authors.initials: L
authors.lastname: Winston
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
mesh_terms: D000900:Anti-Bacterial Agents / Q000600:supply & distribution*; D002140:California / Q000453:epidemiology; D016360:Clostridioides difficile / Q000187:drug effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D016983:Enterococcus / Q000187:drug effects*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007902:Length of Stay; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000600:supply & distribution; D010878:Piperacillin / Q000600:supply & distribution; D000077725:Piperacillin, Tazobactam Drug Combination; D014481:United States; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin