An analysis of data from US hospitals found that ceftolozane-tazobactam and ceftazidime-avibactam are the most frequently used new antibiotics, researchers reported this week in Open Forum Infectious Diseases.
Using data from the PINC-AI database, researchers from the University of Maryland performed a retrospective cohort study of discharges from 832 hospitals from June 2022 through May 2023. The aim of the study was to describe the use of new gram-negative antibiotics—which evidence suggests have been underused—in a recent period, understand the clinical indications for which of these antibiotics are used, and compare the characteristics of patients treated with the new antibiotics against those treated with piperacillin-tazobactam, a widely used older gram-negative antibiotic.
Newer drugs used in only a fraction of new admissions
Overall, more than 3.8 million admissions across 832 hospitals included an antibiotic prescription. New antibiotics were prescribed in 9,768 admissions (0.25% of antibiotic-prescribing admissions) across 537 hospitals, while piperacillin-tazobactam was prescribed in 731,719 admissions (18.8%) and colistin in 570 (0.01%).Â
Use of new antibiotics was clustered among a small subset of hospitals, with 10 hospitals accounting for 25% of new-antibiotic-associated admissions.
Ceftolozane-tazobactam was prescribed in 4,157 admissions (42.6%), ceftazidime-avibactam in 3,660 (37.5%), eravacycline in 1,213 (12.4%), cefiderocol in 1,060 (10.9%), meropenem-vaborbactam in 456 (4.7%), omadacycline in 104 (1.1%), and imipenem-relebactam in 99 (1.0%). Nearly half (46%) of new antibiotics were started in the first 3 days of hospital admission, and 70% were used as definitive therapy. Sepsis (76%), pneumonia (46%), and urinary tract infection (39%) were the most common clinical indications. On average, patients treated with new antibiotics had eight more comorbid conditions and longer hospital stays (median 13 vs 6 days) than patients receiving piperacillin-tazobactam.
The authors say the finding that new antibiotics are being used more frequently than polymyxins suggests that practice is finally catching up with evidence. But newer antibiotics are still being underused.
“Though new Gram-negative antibiotics are not used nearly as frequently as workhorses like piperacillin-tazobactam, their use has largely surpassed less effective and more toxic antibiotics like colistin,” they wrote. “However, the newest antibiotics, such as cefiderocol, meropenem-vaborbactam, and imipenem-cilastatin-relebactam, remain rare in clinical practice.”
