Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia

Fahimi, Fanak; Ghafari, Somayeh; Jamaati, Hamidreza; Baniasadi, Shadi; Tabarsi, Payam; Najafi, Arvin; Akhzarmehr, Arnavaz; Hashemian, Seyed Mohammad Reza

doi:10.4103/0972-5229.102083

Cited by 19 publications

(18 citation statements)

References 37 publications

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“…The majority of studies were excluded during initial screening because they were Monte Carlo simulation studies that did not involve patients, or were studies that did not have a comparator group. Thirty-four studies underwent full text review and 10 met criteria for inclusion [ 13 14 15 16 17 18 19 20 21 22 ] comprising 1,051 patients treated. Figure 1 shows the selection process of studies included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the eligible studies are presented in Table 1 . Four studies were retrospective [ 16 17 18 20 ], one was prospective, parallel, non-randomized [ 22 ] and 5 randomized controlled trials (RCT)s [ 13 15 19 21 22 ]. The selected studies were performed on 4 continents (USA, Europe, Asia, and Australia) and included patients from medical, surgical, and mixed ICUs.…”

Section: Resultsmentioning

confidence: 99%

“…β-lactam antibiotics included cephalosporins [ 13 14 15 17 ], carbapenems [ 16 19 20 21 ] and piperacillin/tazobactam [ 18 22 ]. In the experimental arm, these agents were administered via either continuous infusion [ 13 14 16 17 18 21 ] or extended infusion [ 15 19 20 22 ]. In five of the six studies utilizing a continuous infusion of β-lactam delivery, a loading dose was administered initially to ensure that the time to maximum concentration of the drug is reached rapidly.…”

Section: Resultsmentioning

confidence: 99%

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Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis

2016

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BackgroundThe primary objective of this meta-analysis is aimed at determining whether β-lactams prolonged infusion in patients with nosocomial pneumonia (NP) results in higher cure rate and improved mortality compared to intermittent infusion.Materials and MethodsRelevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL from inception to September 1st, 2015. All published articles which evaluated the outcome of extended/continuous infusion of antimicrobial therapy versus intermittent infusion therapy in the treatment of NP were reviewed.ResultsA total of ten studies were included in the analysis involving 1,051 cases of NP. Prolonged infusion of β-lactams was associated with higher clinical cure rate (OR 2.45, 95% CI, 1.12, 5.37) compared to intermittent infusion. However, there was no significant difference in mortality (OR 0.85, 95% CI 0.63–1.15) between the two groups. Subgroup analysis for β-lactam subclasses and for severity of illness showed comparable outcomes.ConclusionThe limited data available suggest that reduced clinical failure rates when using prolonged infusions of β-lactam antibiotics in critically ill patients with NP. More detailed studies are needed to determine the impact of such strategy on mortality in this patient population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis

2016

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“…It is commonly coformulated with tazobactam (a ␤-lactamase inhibitor) to enhance its activity against ␤-lactamase-producing pathogens (15,16). Piperacillin exhibits time-dependent bacterial killing, meaning that efficacy is determined by the duration that free concentrations are maintained above the MIC (fT MIC ) for the pathogens (17). For piperacillin, an fT MIC of Ն50% of the dosing interval is considered necessary for maximal activity (18).…”

mentioning

confidence: 99%

Population Pharmacokinetics of Piperacillin in Nonobese, Obese, and Morbidly Obese Critically Ill Patients

Alobaid

Wallis

Jarrett

et al. 2017

Antimicrob Agents Chemother

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The treatment of infections in critically ill obese and morbidly obese patients is challenging because of the combined physiological changes that result from obesity and critical illness. The aim of this study was to describe the population pharmacokinetics of piperacillin in a cohort of critically ill patients, including obese and morbidly obese patients. Critically ill patients who received piperacillin-tazobactam were classified according to their body mass index (BMI) as nonobese, obese, and morbidly obese. Plasma samples were collected, and piperacillin concentrations were determined by a validated chromatographic method. Population pharmacokinetic analysis and Monte Carlo dosing simulations were performed using Pmetrics software. Thirty-seven critically ill patients (including 12 obese patients and 12 morbidly obese patients) were enrolled. The patients' mean Ϯ standard deviation age, weight, and BMI were 50 Ϯ 15 years, 104 Ϯ 35 kg, and 38.0 Ϯ 15.0 kg/m 2 , respectively. The concentration-time data were best described by a two-compartment linear model. The mean Ϯ SD parameter estimates for the final covariate model were a clearance of 14.0 Ϯ 7.1 liters/h, a volume of distribution of the central compartment of 49.0 Ϯ 19.0 liters, an intercompartmental clearance from the central compartment to the peripheral compartment of 0.9 Ϯ 0.6 liters · h Ϫ1 , and an intercompartmental clearance from the peripheral compartment to the central compartment of 2.3 Ϯ 2.8 liters · h Ϫ1 . A higher measured creatinine clearance and shorter-duration infusions were associated with a lower likelihood of achieving therapeutic piperacillin exposures in patients in all BMI categories. Piperacillin pharmacokinetics are altered in the presence of obesity and critical illness. As with nonobese patients, prolonged infusions increase the likelihood of achieving therapeutic concentrations.

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“…Validity and reliability of the Persian version of the CPIS is confirmed, and it is used widely in research studies to appraise suspected VAP. [1314]…”

Section: Methodsmentioning

confidence: 99%

Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?

et al. 2016

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Background:Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the intensive care unit (ICU). Patients with type 2 diabetes mellitus (T2DM) are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients.Materials and Methods:This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS) until ICU discharge, VAP diagnosis, or death.Results:Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27–31.9). The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57). Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR): 10.12 [95% confidence interval (CI): 5.1–20.2); P < 0.0001)].Conclusion:The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.

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Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia

Cited by 19 publications

References 37 publications

Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis

Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis

Population Pharmacokinetics of Piperacillin in Nonobese, Obese, and Morbidly Obese Critically Ill Patients

Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?

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