Category: Professional Posters
Purpose: Ertapenem is a broad spectrum carbapenem antibiotic used in the setting of aerobic gram-negative infections. Recent shortages of intravenous (IV) fluids have resulted in healthcare systems converting administration of many medications from IV piggyback to IV push. Recently our institution transitioned ertapenem IV piggyback to IV push. Administering medications via IV push presents numerous advantages such as reduced material cost, improved workflow, and shorter time to first dose; however, increases in adverse drug reactions (ADRs) may occur. The purpose of this analysis was to evaluate the safety profile of ertapenem when administered as IV piggyback compared to IV push.
Methods: This IRB approved, single-center, retrospective study was performed at Brigham and Women’s Hospital in Boston, Massachusetts. The electronic health record was used to identify all patients receiving IV ertapenem therapy from April 1, 2017 through September 30, 2018. Patients ages 18 or older were included in the study if there was a documented administration of IV ertapenem. The major endpoints analyzed were IV site reactions including phlebitis and infiltration. For the presence of each ADR, the Naranjo Nomogram was utilized to assess the causality of the reactions to determine the likelihood of whether the event was caused by the medication itself or other factors, such as concomitant medications. Data is presented as means and standard deviations as well as percentages. Student’s t-test was used to compare means while the chi-squared test was used to compare nominal and categorical variables.
Results: To date, 602 administrations from 174 patients have been analyzed: 283 administrations (92 patients) in the IV push group and 319 administrations (82 patients) in the IV piggyback group. In the IV push cohort there were 255 1000 milligram doses as compared to 262 in the IV piggyback cohort (90.11% vs 82.13%; p-value 0.005). The remaining doses were all 500 mg. The number of IV site reactions was 14 compared to 8 in the IV push versus IV piggyback group, respectively (4.95% vs. 2.51%; p-value 0.11). Nine patients in the IV push cohort experienced infusion site reactions compared to 7 patients in the IV piggyback cohort (3.18% vs 2.19%; p-value 0.45). Eleven (78.57%) of the events in the IV push group were deemed “possible”, 2 (14.29%) deemed “doubtful” while the remaining event was considered “probable” per the Naranjo Nomogram. Of the events in the IV piggyback group, all 8 (100%) were found to be “possible” per the Naranjo Nomogram.
Conclusion: The administration of IV push ertapenem showed similar rates of infusion site reactions compared to IV piggyback on a per administration basis and the infusion site reaction event rate per patient was comparable. Therefore, IV push appears to be a safe and viable method of ertapenem administration as compared to IV piggyback.