1005. Financial and clinical impact of ceftolozane/tazobactam global recall on the treatment of multi-drug resistant Pseudomonas in a large health system

Background

In December 2020, ceftolozane/tazobactam (CT) was voluntarily recalled due to failed sterility tests. With this recall, clinicians were forced to utilize alternatives for multi-drug resistant (MDR) Pseudomonas (PSA) infections until CT returned in late December, 2021. While many studies have examined the impact of medication shortages, few have evaluated the impact of antimicrobial shortages. We evaluated the impact of the CT recall by assessing cost, clinical outcomes, and utilization of novel alternative agents.

Methods

This multi-site retrospective cohort study compared patients treated for MDR PSA prior to the CT recall (Jan-Jul 2020) to patients treated during the CT recall (Jan-Jul 2021) across seven AdventHealth Central Florida (AHCF) adult hospitals. The primary outcome was percentage of patients treated with novel therapies (CT, ceftazidime/avibactam, or cefiderocol). Secondary outcomes included length of therapy (LOT), inpatient mortality, 30-day readmissions, length of say (LOS), pharmacy expenditures, and average cost per case.

Results

A total of 203 patients with MDR PSA were evaluated: 100 in the pre-recall cohort and 103 in the post-recall cohort. The majority (58%) of patients were male with an average age of 64 years. The most common source of infection in both cohorts was pneumonia, followed by complicated urinary tract infection. Significantly more patients were treated with novel agents as definitive therapy in the post-recall cohort (65% vs. 29%, p< 0.0001). Average LOT for all anti-PSA therapy was 12 days in the pre-recall cohort compared to 14 days in the post-recall cohort (p=0.1753). Inpatient mortality and 30-day readmissions were not statistically different between groups. Hospital LOS was significantly different between the two groups (18 days vs. 25 days, p=0.006). Significantly higher pharmacy expenditures were found in the post recall cohort (Figure 1) and the average cost per case was significantly higher in the post-recall cohort ($125,254 vs. $62,249). Figure 1:Pharmacy Expenditures for Novel Agents

Novel agents: cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam

Conclusion

The CT recall had a significant impact on both economic and clinical outcomes, particularly increased length of stay, length of therapy, and cost to both the patient and health system. Higher utilization of novel agents is concerning given rising rates of PSA resistance.

Disclosures

Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.

0223 Interactions Between Home, Work, and Sleep Among Full-Time Firefighters

Introduction

Firefighters endure large occupational burdens (e.g., heat, exposure to toxic fumes, witnessed trauma) and generally operate under conditions of chronic sleep deficiency due to long shifts plus disrupted sleep and circadian disruption due to emergency calls during the night. A typical shift for firefighters is 24-hours on/48-hours off, and firefighters are expected to use time-off to recover from any sleep debt. However, firefighters need to balance that recovery with social/family needs and home maintenance. We conducted focus groups and qualitative analysis of responses to understand how firefighters’ sleep recoverability is affected by occupational burdens and home/family dynamics.

Methods

Focus groups were conducted via convenience sampling in Portland, Oregon, with full-time firefighters, battalion chiefs, and spouses of firefighters to assess current strategies and coping mechanisms used to manage occupational burdens, home/family obligations, and sleep loss based on their 24-hours on/48-hours off shift schedule. Grounded theory, using NVivo 12 plus, was used to code focus group transcripts to reveal reoccurring concepts that were further grouped into themes.

Results

Major themes that emerged among firefighters and spouses (n=48) centered on spousal resentment of firefighters, driven by understanding a firefighters’ heroic occupation and need to recover from accumulated sleep loss and shift schedule, but also wanting a partner physically/emotionally present to share home/social responsibilities. While married firefighters discussed choosing family/home obligations over reducing sleep debt to maintain social/family relationships, single and divorced firefighters spoke of fewer conflicts impeding their ability to prioritize sleep at home.

Conclusion

This study improves our understanding of how work impacts home life in firefighters and can inform future strategies to address work-family conflict and sleep loss concerns, and highlights the importance of managing expectations of time-off to promote a healthier work-life balance.

Support

Oregon Healthy Workforce Center

["Medical Deputies": clinics and politics in the dispute for public resources in Buenos Aires (1906-1917)]

In June 1906, the conservative deputy and doctor Eliseo Cantón submitted in the Argentinian Parliament the project of a <<big polyclinical hospital>>, which would take up four blocks, would be located in front of the Faculty of Medicine of the University of Buenos Aires and would be made up by 20 institutes with a capacity for 80 beds each. The dispute over this huge project, which lasted until 1917, placed in the middle of the scene, a group of "medical deputies" who used the political platform as a space to define the main aspects of the hospital system. The controversy went beyond the Parliament reaching the public sphere. The lavishness of the project on the eve of the Centenary public festivities or the opulence of a Buenos Aires which inspired to be like Paris were related, in a symbolic view, to the progress of local medicine and its aspirations to be included in the international medical arena. The analysed case helps understand how an essentially political controversy - which led to economical, ethical and cognitive discussions - intervened in the process of building up a socio-professional space of the hospital medical practice.