P1835 Simultaneous administration of imipenem/cilastatin/relebactam with selected intravenous medications, a stewardship approach Ghazi Islam*1, Bhumi Mehta1

1 Philadelphia College of Pharmacy, Philadelphia, United States Background:Imipenem/cilastatin/relebactam is a β-lactam/β-lactamase inhibitor with activity against imipenem non-susceptible Pseudomonas as well as KPC-producing Enterobacteriaceae. In hospitalized patients, intravenous (IV) drugs must be infused through separate lines or staggered based on priority, infusion times, and dosing intervals. The availability of y-site compatibility data between potentially co-administered intravenous medications will contribute to direct cost saving, reduce nursing time and enhance the clinical utility in health care settings. We sought to assess the physical compatibility of imipenem/cilastatin/relebactam when diluted for infusion in suitable diluent (0.9% sodium chloride solution for injection) during simulated Y-site administration with common injectable intravenous medications to assist stewardship programs with drug administration protocols. Materials/methods:Using a standard reference method as follows, all medications were reconstituted according to the manufacturer’s recommendations and diluted with 0.9% sodium chloride (where applicable unless tested undiluted) to highest standard concentrations used clinically. Room temperature Y-site conditions were simulated in culture tubes by mixing 5mL imipenem/cilastatin/relebactam solution (imipenem 5 mg/mL) with 5mL of tested drug solutions. Solutions were switched in the order of drug mixing, all combinations were conducted in duplicate and finally were inspected visually against white and black background for clarity, color and Tyndall beam test. Turbidity was measured using a laboratory grade turbidimeter and pH changes were assessed for a 120-minute observation period with checks immediately post-admixture and then at 15, 60, and 120 minutes after mixing. Admixtures were examined for gross precipitation, positive Tyndall beam test, color changes, extreme pH changes, and increase in turbidity. Results:Based on change of ≥ 0.5 nephelometric turbidity units (NTU) cut-off point, imipenem/cilastatin/relebactam was compatible with; albumin, amphotericin B, calcium gluconate, caspofungin, colistimethate, dexamethasone, dobutamine, epinephrine, eptifibatide, esmolol, furosemide, gentamicin, hydrocortisone, labetolol, levofloxacin, magnesium sulfate, mesna, metoprolol, metronidazole, vasopressin. No extreme pH changes, Tyndall effect or color changes were observed. Conclusions:Imipenem/cilastatin/relebactam at the clinically utilized concentration was compatible with all the tested drugs that included antibiotics, cardiovascular and anti-inflammatory agents administered in acute/urgent situations. These data serve to facilitate the administration of imipenem/cilastatin/relebactam to patients receiving other intravenous medications in the acute care setting and lessen the need for a dedicated intravenous line.

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