Scientific Poster Session IV - Original Research

Original Research
  Tuesday, November 14, 2023
  08:30 AM–10:00 AM

Abstract

Introduction: Many healthcare systems have utilized IV push (IVP) administration of medications as a fluid-sparing measure due to ongoing shortages. One such medication is ceftriaxone.

Research Question or Hypothesis: How does the efficacy of IVP ceftriaxone compare to IV piggyback (IVPB) in critically-ill patients?

Study Design: Retrospective, observational cohort study

Methods: Adult intensive care unit (ICU) patients admitted between March 2016-January 2021 who received ceftriaxone = 72h were included. Exclusion criteria were infection with ceftriaxone-intermediate/resistant pathogens, pregnancy, or receipt of both IVPB and IVP. Data points included baseline characteristics, ceftriaxone dose/duration, and clinical outcomes. The primary outcome was treatment failure, defined as a composite of inpatient mortality and escalation of antibiotic therapy due to worsening clinical status. Secondary outcomes included individual composite outcome components. Categorical and continuous variables were evaluated with chi-squared and independent sample t-test, respectively. Binary logistic regression was applied to the primary outcome. P-value <0.05 was considered significant.

Results: In total, 201 IVP and 200 IVPB patients were included with mean SOFA scores of 6.4 and 5.4, respectively (p=0.002). Sepsis and septic shock were more common in the IVP group (sepsis: 56.2% vs. 30.5%, p<0.001; septic shock: 29.4% vs. 10.5%, p<0.001). Treatment failure was more common with IVP administration (37.8% vs. 19.5%, p<0.001), as were each of the individual composite outcome components (all-cause hospital mortality: 21.4% vs. 9.5%, p<0.001; antibiotic escalation: 25.4% vs. 11.5%, p<0.001). After controlling for potentially confounding variables including age, gender, and presence of a positive culture, IVP ceftriaxone (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.43–3.79), therapy duration (OR 0.86, 95% CI 0.78–0.96), and SOFA score (OR 1.18, 95% CI 1.1–1.27) were associated with treatment failure.

Conclusion: IVP ceftriaxone was associated with higher treatment failure. Limitations include single-center retrospective design and higher acuity in the IVP group. Nevertheless, findings suggest a possible benefit to IVPB ceftriaxone in critically ill patients.

Presenting Author

Elly R. Sherman Pharm.D. Candidate
University of Georgia

Authors

Christopher M. Bland Pharm.D., FCCP, FIDSA, BCPS
University of Georgia College of Pharmacy

Trisha N. Branan PharmD, BCCCP, FCCM
University of Georgia College of Pharmacy

Natt Patimavirujh Pharm.D.
UGA College of Pharmacy

L. Ashton Dickinson Pharm.D. Candidate
University of Georgia College of Pharmacy

Susan E. Smith PharmD, BCPS, BCCCP, FCCM
University of Georgia College of Pharmacy

Nha (Kelly) Ta Pharm.D. Candidate