178 Hospital Pharmacy 54(3) Figure 1. Factors influencing and deterring carbapenem use among providers. Note. Figure 1a represents factors influencing carbapenem prescription in order of most important to least important. Figure 1b represents factors deterring carbapenem use in order of most likely to least likely. MDR = multidrug resistant; rec. = recommendation; ID = infectious disease service. Table 2. Multiple-Choice Survey Questions and Answers. Answer choice PGY-1 PGY-2 PGY-3 PGY-4, 5, or fellow Attending physician Overall Question 1. Which of the following statements is correct regarding penicillin drug allergy and beta-lactam cross reactivity? All carbapenems and cephalosporins have similar rates of 17.0% 11.5% 5.4% 35.7% 15.8% 17.0% cross reactivity Carbapenems and advanced-generation cephalosporins have low 51.1% 53.9% 66.7% 35.7% 52.6% 51.1% (i.e. ≤1%) rates of cross reactivity Carbapenems do not pose a risk for cross reactivity 9.6% 7.7% 5.6% 7.2% 10.5% 9.6% Carbapenems have a lower likelihood of cross reactivity 22.3% 26.9% 22.3% 21.4% 21.1% 22.3% than cefepime Question 2. Based on the institutional antibiogram, which of the following antibiotics is P aeruginosa most likely to be susceptible to? Piperacillin-tazobactam 47.4% 42.3% 47.4% 50.0% 42.1% 47.4% Cefepime 29.5% 23.1% 36.8% 42.9% 36.8% 29.5% Aztreonam 4.2% 3.9% 5.3% 0.0% 5.3% 4.2% Meropenem 18.9% 30.7% 10.5% 7.1% 15.8% 18.9% Question 3. True or false. Beta-lactam/beta-lactamase inhibitors (i.e. piperacillin-tazobactam) are inferior to carbapenems to treat bloodstream infections caused by ESBL-producing Enterobacteriaceae from low inoculum sources of infection (i.e. urinary, biliary). True 52.6% 57.7% 52.6% 64.3% 36.8% 52.6% False 47.4% 42.3% 47.4% 35.7% 63.2% 47.4% Note. Correct responses for each question denoted by italicized font. PGY = postgraduate year; ESBL = extended-spectrum beta-lactamase. evidence supporting the use of BLBLIs in the treatment of infections caused by ESBL-producing Enterobacteriaceae, despite evidence showing BLBLIs to be an equally efficacious, carbapenem-sparing option for the treatment of these infections in certain scenarios.7 Based on these results, providers may have an underappreciation of the value of local susceptibility rates when choosing to use a carbapenem, and misconceptions in both of these areas may contribute to carbapenem overutilization. Another finding of this survey is that despite the presence of drug allergies being identified as one of the most important factors considered when prescribing a carbapenem, only about half of respondents selected that there is an equal (albeit low) likelihood for patients with a history of an immediate hypersensitivity reaction to penicillin to also have an allergic reaction to a carbapenem or advanced-generation cephalosporin. Nearly one-quarter of respondents suggested that carbapenems pose a lower risk of cross reactivity than