Assessment of the Impact of an Antibiotic Shortage: Patient Outcomes and Costs

Abstract

During the piperacillin/tazobactam (P/T) shortage of 2002, alternative antibiotics were recommended and used at our institution. The purpose of this analysis was to identify which antibiotics were used as substitutes and the effect that this substitution had on antibiotic expenditures and patient outcomes. The study was conducted at a 600-bed tertiary care, teaching institution. To assess the effects of the shortage, P/T and alternative antibiotic use for P/T indications was quantified and normalized for hospital census over the period of the shortage (March 1 to August 30, 2002). Cost was determined from actual purchase prices. For the same time period, numbers of patients with diagnoses related to potential P/T use, their in-house mortality, and length of stay (LOS) were also quantified. Antibiotic use, cost, and patient outcomes were compared with the same time period during 2001. The shortage of P/T during 2002 was, for the most part, accommodated by increased use of cefepime (146% increase), ticarcillin/clavulanate, and antibiotics with antianaerobic activity. The number of cases and in-house morbidity for targeted ICD-9s were largely unchanged over the two comparative time periods (P > 0.05). However, cumulative LOS decreased by 1.7 days and, although overall drug use increased 4.9%, total antibiotic expenditures for P/T and its alternatives decreased by 11.7% during the shortage. Patient outcomes were not adversely affected during the P/T shortage of 2002 and the use of alternative agents was associated with decreased LOS and cost reductions for the institution.