Abstract
AbstractPurpose: This study evaluated the clinical outcomes of a hospital-wide initiative of a 4-h prolonged infusion piperacillin–tazobactam (pip–tz) vs. a 30-min and a 4-h prolonged infusion. Methods: This retrospective study included patients who received pip–tz by two different infusion models with a documented or suspected Gram-negative infection. Patients can receive a 30-min infusion then a 4-h infusion or a 4-h infusion of pip–tz. The study’s primary outcomes were length of stay (LOS) and 30-day mortality. Findings: Seventy-four patients received both types of infusion (SP) and 275 patients received only the prolonged infusion (PI). Using univariate analysis, the PI group had a higher mortality rate (13%) vs. SP group (4%) (p = 0.033). The PI group had a higher mean LOS (12.6 ± 9.5 days) vs. the SP group (10.3 ± 8.2 days) (p = 0.04). The type of infusion was not a significant predictor of LOS or mortality in multiple regression analysis (p > 0.05). Implications: This preliminary study showed that ...
Highlights
The growing acceptance of prolonged infusion of piperacillin–tazobactam has been well documented (Lodise, Lomaestro, & Drusano, 2007; Patel et al, 2009; Xamplas et al, 2010; Zvonar & Kanji, 2010)
Study results show that patients who received the 30-min infusion prior to the prolonged infusion of piperacillin–tazobactam had statistically significantly lower rates of mortality, 4% vs. 13%, and a shorter hospitalization period, 10.3 days vs. 12.6 days
There is no consensus on when to initiate a prolonged infusion of piperacillin–tazobactam
Summary
The growing acceptance of prolonged infusion of piperacillin–tazobactam has been well documented (Lodise, Lomaestro, & Drusano, 2007; Patel et al, 2009; Xamplas et al, 2010; Zvonar & Kanji, 2010). All patients coming to the ED or intensive care unit (ICU) for medical treatment, where IV line access is problematic, can receive a 30-min infusion of piperacillin–tazobactam prior to a prolonged (4-h) infusion after 6-h. Using a 30-min infusion instead of a 4-h infusion allows for greater intravenous line access for other intravenous medications that need to be given but are incompatible with piperacillin–tazobactam. One concern of using prolonged infusion was the impact it would have on patient survival based on sufficient drug levels within the first few hours of antibiotic administration (time to appropriate). The rate of survival drops with every hour of delay in antibiotic administration (Siddiqui, Salahuddin, Raza, & Razzak, 2009)
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