11/5/08
Infectious Diseases Society of America Emerging Infections Network Report for Query: ‘Penicillin Breakpoints For Non-meningitis Pneumococcal Disease Isolates’
Overall response rate: 588/1247 (47.2%) physicians responded from 9/30/08 to 11/4/08. Note: Not all respondents answered all questions, so totals for individual questions vary. *No further data provided for the 59 respondents who reported not caring for patients with pneumococcal disease.
Question 1. Regarding the 2008 change in penicillin breakpoints: How did you How would you like learn about it? to learn about it? IDSA News 273 (52%) 297 (56%) CLSI official document 69 (13%) 176 (33%) Penicillin package insert 7 (1%) 26 (5%) From a pharmaceutical representative 5 (1%) 11 (2%) From a colleague 128 (24%) 76 (14%) From a pharmacist 41 (8%) 57 (11%) At a national conference 46 (9%) 106 (20%) Micro lab susceptibility reporting 138 (26%) 183 (35%) This survey 147 (28%) --Other* 33 (6%) 39 (7%) *Journal including MMWR (N=20), Clinical microbiology laboratory (N=14), Official agency notification including CDC/FDA/State Health Dept (N=8), Online/internet source including Up To Date/Epocrates (N=6) Question 2. Before 1/08, how often was IV penicillin chosen when caring for hospitalized patients with penicillin-susceptible non-meningitis pneumococcal infections? By you By non-ID referring physicians Frequently 193 (37%) 17 (3%) Infrequently 314 (59%) 407 (77%) N/A or do not know / default 22 (4%) 105 (20%)
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Question 3. Since 1/08, how likely are you, or the referring physician, to use IV penicillin when treating the non-allergic pneumococcal pneumonia patient? You The non-ID referring physician Much more likely 78 (15%) 5 (1%) Somewhat more likely 193 (36%) 54 (10%) No change 226 (43%) 292 (55%) Somewhat less likely 10 (2%) 17 (3%) Much less likely 10 (2%) 25 (5%) Do not know 12 (2%) 136 (26%) Question 4. What are the barriers to using IV penicillin for a patient with pneumonia due to a penicillin-susceptible pneumococcus? You The non-ID referring physician None; would use penicillin 261 (49%) 19 (4%) Confusing susceptibility reports 10 (2%) 220 (41%) Pt improving on initial regimen 90 (17%) 341 (64%) Use empiric regimen preferred by hospital 96 (18%) 247 (47%) Pt already switched to oral therapy 216 (41%) 183 (35%) High rate of adverse events with PCN 17 (3%) 24 (5%) More comfortable dosing other antibiotics 59 (11%) 154 (29%) PCN dosing schedule too frequent 257 (49%) 203 (38%) Other barrier* 36 (7%) 36 (7%) *Penicillin shortage/availability (N=10); high cost of IV penicillin (N=7); use ampicillin instead and switch to amoxicillin (N=7); CAP guidelines foster use of broad spectrum agents (N=3); efficacy, convenience, cost effectiveness of once daily ceftriaxone or once daily fluoroquinolone (N=2); IV access issues in small children (N=3); often don’t have an organism or culture to guide antibiotics (N=3); non-ID physicians believe that penicillin is “old fashioned”, “inferior”, “not as strong” (N=4); known allergy (N=2) Question 5. Does your clinical micro lab report separately susceptibilities for meningitis and non-meningitis pneumococcal isolates? Yes 324 (61%) No 122 (23%) Do not know / default 83 (16%) Question 6. Rate the ease of understanding the interpretations for S. pneumoniae susceptibility results provided by your clinical micro lab: Very easy 234 (46%) Somewhat easy 231 (45%) Somewhat confusing 44 (9%) Very confusing 3 (0.6%)
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Question 7. Do you remember how you learned about the Jan 2003 new cefotaxime and ceftriaxone breakpoints for pneumococcus? Yes* 176 (34%) No 294 (56%) Not aware of the change 52 (10%) *Clinical Micro Lab including from the Lab Director (N=54), Infectious Diseases News (N=12), publications (N=20), IDSA (N=21), NCCLS/CLSI document (N=14), Grand rounds/local ID conference (N=11), Colleagues (N=13), ASM or ICAAC (N=4) Question 8. Has PCN use been encouraged for penicillin-susceptible non-meningitis pneumococcal infections in your institution(s)? Yes 80 (15%) No 379 (72%) Do not know / default 70 (13%) Question 9. Has the actual use of PCN increased? [Results provided only for those who answered Yes to Question 8, N=80] Yes 18 (23%) No 21 (26%) Do not know 41 (51%)
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