Appropriateness of piperacillin-tazobactam prescriptions: a prospective multicentre study

Abstract

Introduction: Our aim was to determine the reasons for appropriate Piperacillin-tazobactam (Pip-Taz) prescriptions.

Method: This was a prospective multicentre study of two-month Pip-Taz prescription in France. Reading of patient charts allowed for classification of diagnoses as definitive, suspected or unknown. Appropriateness of Pip-Taz was defined according to eight indications: post-operative infection in digestive surgery or urology, fever in onco-hematological patients, healthcare-associated infections (HCAI) in intensive care units, polymicrobial HCAI, infection due to multidrug-resistant bacteria, avoidance of carbapenem use, pulmonary infection in patients with chronic pulmonary disease, and following an internal guideline. Antibiotic reassessment was defined by any modification of Pip-Taz. Risk factors for erroneous Pip-Taz prescription were identified through a multivariate analysis, and participating physicians were interrogated on the subject.

Results: From April to July 2024, 259 prescriptions from 14 institutions were included. The diagnosis of infection was definitive in 127 cases (49 %), suspected in 97 (37 %), and unknown in 37 (14 %). Prescriptions were deemed appropriate in 204 cases (79 %). In logistic regression, appropriate Pip-Taz prescription was associated with definitive diagnoses, HCAI, microbiological investigations, advice by infectious disease specialists, and antibiotic reassessment (all adjusted OR ≥ 2.19). All in all, 37/55 prescriptions outside the scope of guidelines were elucidated by the prescribers, the main reason for them being "out of habit" (13/37), and we found a relationship between "unknown diagnosis" and no explanation for Pip-Taz prescription (p < 0.001).

Conclusion: Pip-Taz appropriateness was associated with correct management, i.e. written diagnosis, microbiological investigation, and reassessment, while prescriptions outside guidelines were related to physician habits, including no written diagnosis.

Keywords: Antibiotic reassessment; Antimicrobial stewardship; Audit; Diagnostic uncertainty; Piperacillin-tazobactam.