Continuous versus intermittent piperacillin/tazobactam infusion in infection due to or suspected pseudomonas aeruginosa

Cotrina-Luque, Jesús; Gil-Navarro, María Victoria; Acosta-García, Héctor; Alfaro-Lara, Eva Rocío; Luque‐Márquez, Rafael; Beltrán-García, Margarita; Paloma, Francisco Javier Bautista

doi:10.1007/s11096-015-0208-y

Cited by 23 publications

(36 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An additional two studies that met the inclusion criteria were acknowledged through checking references of relevant studies. Twenty-three studies met the described inclusion criteria and were included in the systematic review (13,14,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)15,33,34,(16)(17)(18)(19)(20)(21)(22). The article selection process is illustrated in Figure.1 and selected studies comparing clinical outcome between CI and II of piperacillin are listed in Table.2.…”

Section: Search Resultsmentioning

confidence: 99%

“…Fifteen of the included studies reported length of hospital stay (13,14,31,33,34,36,38,15,16,18,23,24,26,29,30). Pooling of studies showed that patients receiving C/PI had a signi cantly shorter length of hospital stay (2101 patients; Mean Difference -1.27, 95% C.I -2.45-0.08, P = 0.04; Figure 9) The meta-analysis suggests there is a signi cant reduction in the length of hospital stay in patients receiving C/PI compared to those receiving II.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

See 1 more Smart Citation

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Fawaz¹,

Barton²,

Nabhani‐Gebara³

2020

Preprint

View full text Add to dashboard Cite

Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy. Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager. Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (Odds Ratio 1.56, 95% Confidence Interval 1.28-1.90, P = 0 .0001), lower mortality rates (Odds Ratio 0.68, 95% Confidence Interval 0.55-0.84, P = 0 .0003), higher microbiological success rates (Odds Ratio 1.52, 95% Confidence Interval 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (Mean Difference -1.27, 95% Confidence Interval -2.45—0.08, P = 0.04) in critically ill patients.Conclusion: Results from this study show that there is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. However, more rigorous scientific studies in critically ill patients are warranted to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy.

show abstract

Section: Search Resultsmentioning

confidence: 99%

Section: Length Of Hospital Staymentioning

confidence: 99%

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Fawaz¹,

Barton²,

Nabhani‐Gebara³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Eighteen of the included studies reported patient mortality rates (Table 1) (13,14,(28)(29)(30)(31)(32)(33)(34)36,(15)(16)(17)(18)20,21,24,27). Statistically significantly fewer mortality rates were found among patients receiving C/PI compared with patients receiving conventional II (3100 patients; OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003; Fig.…”

Section: Mortalitymentioning

confidence: 99%

“…Fifteen of the included studies reported length of hospital stay (13,14,31,(33)(34)(35)37,15,16,18,23,24,26,29,30). Pooling of studies showed that patients receiving C/PI had a significantly shorter length of hospital stay (2101 patients; OR -1.27, 95% C.I -2.45-0.08, P = 0.04; Fig.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Fawaz¹,

Barton²,

Nabhani‐Gebara³

2020

Preprint

View full text Add to dashboard Cite

Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically-ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy. Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager. Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (OR 1.56, 95% C.I 1.28-1.90, P = 0 .0001), lower mortality rates (OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003), higher microbiological success rates (OR 1.52, 95% C.I 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (OR -1.27, 95% C.I -2.45—0.08, P = 0.04) in critically ill patients. Conclusion: There is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. Therefore, this alternative infusion strategy could be recommended in clinical practice.

show abstract

“…The use of extended or continuous infusion of β-lactam antibiotics (particularly P/T and CPs) compared with intermittent infusion therapy has been associated with improved outcomes in several, 371,372 but not all, 373 studies of PA infections. Randomized controlled trials are limited and the value and indications for extended/continuous infusion remain controversial.…”

Section: Pharmacokinetics/pharmacodynamicsmentioning

confidence: 99%

Emergence of Antimicrobial Resistance among Pseudomonas aeruginosa: Implications for Therapy

Lynch

Zhanel

Clark

2017

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Pseudomonas aeruginosa (PA), a nonlactose fermenting gram-negative bacillus, is a common cause of nosocomial infections in critically ill or debilitated patients, particularly ventilator-associated pneumonia (VAP), and infections of bloodstream, urinary tract, intra-abdominal, wounds/skin/soft tissue. PA rarely affects healthy individuals, but may cause serious infections in patients with chronic structural lung disease, comorbidities, advanced age, impaired immune defenses, or with medical devices (e.g., urinary or intravascular catheters, foreign bodies). Treatment of pseudomonal infections is difficult, as PA is intrinsically resistant to multiple antimicrobials, and may acquire new resistance determinants even while on antimicrobial therapy. Mortality associated with pseudomonal VAP or bacteremias is high (> 35%) and optimal therapy is controversial. Over the past three decades, antimicrobial resistance among PA has escalated globally, via dissemination of several international multidrug-resistant “epidemic” clones. We review the emergence of antimicrobial resistance to this pathogen, and discuss approaches to therapy (both empirical and definitive).

show abstract

Continuous versus intermittent piperacillin/tazobactam infusion in infection due to or suspected pseudomonas aeruginosa

Cited by 23 publications

References 16 publications

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Emergence of Antimicrobial Resistance among Pseudomonas aeruginosa: Implications for Therapy

Contact Info

Product

Resources

About