Pharmacoepidemiology of Ceftazidime-Avibactam Use: A Retrospective Cohort Analysis of 210 US Hospitals. (28th February 2020)

• Record Type: Journal Article
• Authors: Strich, Jeffrey R; Ricotta, Emily; Warner, Sarah; Lai, Yi Ling; Demirkale, Cumhur Y; Hohmann, Samuel F; Rhee, Chanu; Klompas, Michael; Palmore, Tara; Powers, John H; Dekker, John P; Adjemian, Jennifer; Matsouaka, Roland; Woods, Christopher W; Danner, Robert L; Kadri, Sameer S
• Is Part Of: Clinical infectious diseases. Volume 72:Number 4(2021)
• Page Start: 611
• Page End: 621
• Publication Date: 2020-02-28
• Subjects: ceftazidime-avibactam -- ram-negative resistance -- novel beta-lactamase inhibitors -- carbapenem resistance; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa061
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: 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 hospital formularies, 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. Abstract : Since US Food and Drug Administration approval in 2015, ceftazidime-avibactam utilization has increased almost 20-fold over 3 years, corresponding to a concomitant decrease in colistin utilization. Renal function appears to be the strongest predictor that a patient will receive targeted ceftazidime-avibactam versus colistin.