Empirical use of Temocillin in hospitalized patients: a retrospective study on clinical effectiveness, outcome, and mortality rates at a large district hospital, East of England, UK Kandil H, Gray R.M, El-Hamad R, VaghelaT, Vidwans M West Hertfordshire Hospitals NHS Trust, UK Correspondence: [email protected] Outline With the national shortage of piperacillin/tazobactam in the UK in Microbiology consultant and antimicrobial lead the period between May and July 20171 we introduced temocillin into our trust In total we analysed 126 patients using their discharge summaries, guidelines for the empirical treatment of infection. The aim of this study is to Results microbiology and biochemical results, and when required, primary patient files. assess the clinical effectiveness of temocillin and outcome when used as an Figure 1: Outcomes The most common indication of therapy was intra-abdominal infections (39%). The empirical therapy for various indications including intra-abdominal infections duration of therapy ranged from 3-14 days. In 92% of the cases, temocillin was (IAIs) an indication for which it is not currently licensed in the UK. We also given empirically. The overall success rate was 89% Sub-analysis for IAI also gave assessed the associated hospital-acquired clostridium difficile infections (HA- a success rate of 89%. CDI) and Hospital Standardised Mortality Rate (HSMR) during this period. Additionally one patient was tested clostridium difficile antigen positive and another toxin positive. Both patients had received piperacillin/tazobactam prior to temocillin. Background To replace piperacillin/tazobactam during the period of short Of the 14 cases of treatment failure,13 were primary failure and 1 was a relapse supply, we used temocillin as the backbone of empirical regimes treating within 7 days. Of the 13 failures, 4 were due to inappropriate antibiotic coverage inpatients at Watford General- a 520 bed hospital. Despite a relatively narrow with antibiotics changed on the basis of a subsequent I.D. of an isolate. 4 of the spectrum limited to gram negative organisms, temocillin is crucially stabe remaining 9 cases had their antibiotics escalated empirically due to poor clinical against many penicillinases making it effective versus highly resistant ESBL response, and achieved a successful outcome. There were 4 deaths despite and ampC producing species2. Secondly, temocillin has been associated with escalation to meropenem, and one patient died after withdrawal of antibiotic relatively low rates of C. difficile infections3. To expand its spectrum, we treatment. combined temocillin with various other antibioitics. HSMR was significantly reduced during and 3 months following the shortage when compared to the same period in the preceding year (85.38 vs 95.96) and a 50% reduction in HA-CDI was also seen. Methods Between May to August 2017 we promoted the use of the following temocillin based empirical regimes: Urinary Tract Infection (UTI) Discussion To our knowledge this is the first study to investigate the clinical temocillin alone, Hospital Acquired Pneumonia (HAP): Temocillin plus effectiveness of temocillin as an empirical therapy in a relatively large cohort of amoxicillin, Sepsis of Unknown Source (SUS) Temocillin plus amoxicillin plus patients and to include outcomes in intarabdominal infections. Our data on 3,4 metronidazole, Intra-abdominal Infection (IAI) Temocillin plus metronidazole. temocillin effectiveness is comparable to that of other published studies . The Careful consideration of the likelihood of Pseudomonal infection was high success rate and low rates of C. difficile are encouraging for its empirical use. Analysis of cost effectiveness is now required. considered, including analysis of prior microbiology results, and gentamicin was added whenever Pseudomonas was suspected. We performed a References 1. http://www.bsac.org.uk/wp-content/uploads/2017/04/Guideline-pip-taz-shortage-final.pdf retrospective analysis of all patients in whom these regimes were used, 2. Livermore DM, Tulkens PM. Temocillin revived. J Antimicrob Chemother. 2009;63:243–245. excluding patients receiving less than 3 days of temocillin. Clinical success 3. Habayeb H, et al. Amoxicillin plus temocillin as an alternative empiric therapy for the treatment of severe hospital-acquired pneumonia: was defined as clinical improvement with no need for escalation in antibioitcs, results from a retrospective audit. European Journal of Clinical Microbiology & Infectious Diseases. 2015;34(8):1693-1699. and no relapse requiring repeat treatment within 7 days of completing the 4. Balakrishnan I, et al. Temocillin use in England: clinical and microbiological efficacies in infections caused by extended-spectrum and/or antibioitc course. derepressed AmpC β-lactamase-producing Enterobacteriaceae. J Antimicrob Chemother. 2011 Nov;66(11):2628-31