Uptake in newly approved antibiotics prescribed to patients with carbapenem-resistant Enterobacterales (CRE)

Abstract

We assessed trends in treatment of patients with CRE from 2012 through 2018. We detected decreased utilization of aminoglycosides and colistin and increased utilization in extended-spectrum cephalosporins and ceftazidime-avibactam. We found significant uptake of ceftazidime-avibactam, a newly approved antibiotic, to treat CRE infections.

Figure 1a:. Trends in Antibiotics Prescribed to Veterans with non-BSI cultures positive for CRE^1–3

¹p values for trend: aminoglycosides <0.0001; carbapenems 0.7985; polymyxins <0.0001; fluoroquinolones <0.0001; extended spectrum cephalosporins <0.0001; penicillins 0.4559; and ceftazidime/avibactam. ²Ceftazidime/avibactam was approved by the U.S. Food and Drug Administration February 2015 and was available for distribution April 2015. Ceftazidime/avibactam was added to the national VA formulary in December 2015 restricted to infectious disease specialists or facility-authorized provider (when infectious disease specialists are not available at the individual facility). ³Extended spectrum cephalosporins included third and fourth generation cephalosporins; only ceftazidime and cefepime were prescribed. Cefiderocol was not FDA approved during the study period.

Figure 1b:. Trends in Antibiotics Prescribed to Veterans with BSI cultures positive for CRE^1–3

¹p value for trends: aminoglycosides 0.0026; carbapenems 0.4741; polymyxins 0.0019; fluoroquinolones 0.6411; extended spectrum cephalosporins <0.0001; penicillins 0.7110; and ceftazidime/avibactam ²Ceftazidime/avibactam was approved by the U.S. Food and Drug Administration February 2015 and was available for distribution April 2015. Ceftazidime/avibactam was added to the national VA formulary in December 2015 restricted to infectious disease specialists or facility-authorized provider (when infectious disease specialists are not available at the individual facility). ³Extended spectrum cephalosporins included third and fourth generation cephalosporins; only ceftazidime and cefepime were prescribed. Cefiderocol was not FDA approved during the study period.