Evaluation of Piperacillin/Tazobactam Use and Resistance Pattern in a Teaching Hospital, Northwest Iran

Inappropriate use of broad-spectrum antibiotics has contributed to the emergence of resistant microorganisms, increased treatment costs, morbidity and mortality, drug toxicity, and prolonged hospitalization period. Determining the epidemiology of antibiotic resistance in various hospital wards allows for more precise drug selection in the hospital setting. This study evaluated the use and resistance pattern of a broad-spectrum antibiotic, Piperacillin/tazobactam, in Imam Khomeini, a referral teaching hospital in Urmia, Iran. 

All hospitalized patients who were treated with Piperacillin\Tazobactam from January to August 2018 were included. Demographic (age, sex, weight, comorbidities) and clinical data (Indication, dosing, duration of the treatment, susceptibility test, creatinine clearance, need for dose adjustment, clinical outcome, and mortality) of the patients were collected, and the compliance of piperacillin\tazobactam administration and its resistance pattern was assessed according to Lexi-comp- 2019 recommendations. 

Among 177 patients, 88.7% received piperacillin\tazobactam without any appropriate susceptibility tests. The piperacillin disk was used in only 33.3% of the culture-positive cases in our research, with 70% resistance. Acinetobacter was the most common bacteria found in our culture-positive samples. The average duration of piperacillin\tazobactam treatment was 8.52 ± 5.84 days. Indications in 8.5%, doses in 18.5%, prescription period in 19.7%, and dose intervals in 31.4% of the cases were inappropriate. Piperacillin\tazobactam was mainly administered for pneumonia (34.5%) 

This study showed an injudicious use of Piperacillin/tazobactam in our hospital, evidenced by the significant number of inappropriate doses, intervals, and treatment duration. Decision-making based on susceptibility tests using appropriate and accurate methods, close monitoring of the patients' clinical status, including creatinine clearance, and antimicrobial stewardship programs may optimize the rational administration of broad-spectrum antimicrobials and avoid the emergence of bacterial resistance.