Extended-Infusion versus Standard-Infusion Piperacillin-Tazobactam for Sepsis Syndromes at a Tertiary Medical Center.
Antimicrob Agents Chemother. 2014 May 27;
Authors: Cutro SR, Holzman R, Dubrovskaya Y, Chen XJ, Ahuja T, Scipione MR, Chen D, Papadopoulos J, Phillips M, Mehta SA
BACKGROUND: Piperacillin-tazobactam (PTZ) is frequently used as both empiric and targeted therapy for Gram-negative sepsis. Time-dependent killing properties of PTZ support the use of extended-infusion (EI) dosing, however studies have shown inconsistent benefits of EI PTZ on clinical outcomes.
METHODS: We performed a retrospective cohort study of adult patients who received EI PTZ and historical controls who received standard-infusion (SI) PTZ for presumed sepsis syndromes. Data on mortality, clinical outcomes, length of stay (LOS), and disease severity were obtained.
RESULTS: A total of 843 patients, 662 who received EI and 181 who received SI, were available for analysis. Baseline characteristics of both groups were similar, except for fewer females receiving EI. No significant differences were observed between EI and SI groups in inpatient mortality (10.9% vs. 13.8%, p=0.282), overall LOS (10 vs. 12 days, p=0.171), ICU LOS (7 vs. 6 days, p=0.061), or clinical failure (18.4% vs. 19.9%, p=0.756). However, duration of PTZ therapy was shorter in the EI group (5 vs. 6 days, p<0.001). Among ICU patients, no significant differences in outcomes were observed between EI and SI groups. Patients with a urinary or intra-abdominal infection had lower mortality and clinical failure rates when receiving EI PTZ.
CONCLUSIONS: We did not observe significant differences in inpatient mortality, overall LOS, ICU LOS, or clinical failure between patients receiving EI PTZ and patients receiving SI PTZ. Patients receiving EI PTZ had a shorter duration of PTZ therapy compared to patients receiving SI, and EI dosing may provide cost savings to hospitals.
PMID: 24867975 [PubMed - as supplied by publisher]