No to Pip-Tazo: Identifying Inappropriate Use of Piperacillin-Tazobactam for Treatment of Skin and Soft Tissue Infections.

Background: Overuse of broad-spectrum antibiotics for the treatment of skin and soft tissue infections (SSTIs) is common. The objective of this study is to identify inappropriate use of piperacillin-tazobactam in the setting of SSTIs to help enhance future stewardship efforts to promote guideline concordant treatments of SSTIs at our institution. Methods: Pharmacy records of all piperacillin-tazobactam orders from October 2013 to June 2015 were retrospectively reviewed at a tertiary Veterans Affairs (VA) medical center. Empiric piperacillin-tazobactam use for patients admitted with SSTIs was identified and evaluated for inappropriateness according to infection type (diabetic foot infection, nonpurulent, purulent, surgical site infection) and severity (mild, moderate, severe) based on institutional and national guidelines. Results: Piperacillin-tazobactam was ordered empirically in 212 SSTI episodes, 166 of which were started in the emergency department. One hundred fifty-two patients had piperacillin-tazobactam orders continued or started on admission; of these, only 40 uses (26.3%) were appropriate, with use in severe infection associated with the highest rate of appropriateness compared with moderate or mild infection (severe, 50.0%; moderate, 12.5%; mild, 15.3%; P

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