BACKGROUND AND AIMS: Ventilator-associated pneumonia (VAP) is one of the most common Intensive Care Unit (ICU)-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin-tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS).
SUBJECTS AND METHODS: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g) either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II) group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI) group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients.
RESULTS: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31) and II (n = 30) groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization.
CONCLUSION: There was no significant difference in clinical outcomes of patients receiving piperacillin-tazobactam via CI or II when measured by serial CPIS score.
BACKGROUND: Prolonged infusions of β-lactams are increasingly being utilized because of increased antimicrobial resistance and a lack of new antibiotics in the pipeline.
METHODS: A retrospective, observational study evaluated adult patients who received at least 72 hours of piperacillin-tazobactam or meropenem in a medical and surgical intensive care unit (ICU) at an academic medical center. In the first 6 months of the study, all patients received conventional intermittent dosing; in the second 6 months, all patients received these antibiotics by prolonged infusions. The main outcome comparisons between groups were duration of ventilator support, duration of ICU and hospital length of stay, and in-hospital mortality.
RESULTS: A total of 121 patients were included: 54 patients in the intermittent (67% piperacillin-tazobactam, 33% meropenem) and 67 patients in the prolonged group (81% piperacillin-tazobactam, 19% meropenem). The prolonged group demonstrated a significant decrease in ventilator days (−7.2 days; 95% confidence interval [CI], −12.4 to −2.4), ICU length of stay (−4.5 days; 95% CI, −8.3 to −1.4), and hospital length of stay (−8.5 days; 95% CI, −18.7 to −1.2) compared with the intermittent group. The risk of in-hospital mortality was 12.4% in the prolonged infusion group and 20.7% in the intermittent infusion group corresponding to an odds ratio of 0.54 (0.18-1.66).
CONCLUSIONS: The results of this study show that the use of prolonged infusions of piperacillin-tazobactam and meropenem could potentially improve clinical outcomes in critically ill populations. As antibiotic resistance continues to increase in gram-negative pathogens, these β-lactam dosing strategies will be important for appropriate treatment.
Infective endocarditis (IE) is the fourth leading cause of life-threatening infection in the United States and imposes significant morbidity and mortality. The American Heart Association guidelines for the diagnosis and treatment of IE do not address continuous-infusion (CI) oxacillin. This retrospective study compares outcomes between CI oxacillin and intermittent-infusion (II) oxacillin in the treatment of IE caused by methicillin-susceptible Staphylococcus aureus (MSSA). A total of 709 medical records were reviewed for inpatients with definitive IE treated between 1 January 2000 and 31 December 2007. Continuous data were analyzed by Student's t test or the Wilcoxon rank sum test. The chi-square test or Fisher's exact test was used to compare nominal data. A multivariate logistic model was constructed. One hundred seven patients met eligibility criteria for inclusion into the study. Seventy-eight patients received CI oxacillin, whereas 28 received II oxacillin. CI and II groups were similar with respect to 30-day mortality (8% versus 10%, P = 0.7) and length of stay (20 versus 25 days, P = 0.4) but differed in 30-day microbiological cure (94% versus 79%, P = 0.03). Sixty-three patients received synergistic gentamicin, whereas 44 did not. The gentamicin and no-gentamicin groups were similar with respect to 30-day mortality (11% versus 4%, P = 0.2) and 30-day microbiological cure (90% versus 89%, P = 0.8); however, times to defervescence (4 versus 2 days, P = 0.02) were significantly different. CI oxacillin is an effective alternative to II oxacillin for the treatment of IE caused by MSSA and may improve microbiological cure. This convenient and pharmacodynamically optimized dosing regimen for oxacillin deserves consideration for patients with IE caused by MSSA.
