Selection of piperacillin/tazobactam infusion mode guided by SOFA score in cancer patients with hospital-acquired pneumonia: a randomized controlled study

Lyu, Yang; Yang, Yang; Li, Xin; Peng, Min; He, Xin; Zhang, Peng; Dong, Siming; Wang, Wanhua; Wang, Donghao

doi:10.2147/tcrm.s145681

Cited by 7 publications

(31 citation statements)

References 11 publications

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“…Lyu et al 41 investigated the infusion modes of piperacillin/tazobactam guided by SOFA score in cancer patients with postoperative HAP. Compared to conventional infusion (30 minutes), prolonged infusion improved patient survival, increased clinical efficacy and bacteriologic efficacy, and reduced 28-day mortality ( P <0.05).…”

Section: Resultsmentioning

confidence: 99%

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Zhu¹,

Zhou²

2018

IDR

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BackgroundSporadic studies in antimicrobial therapy have evaluated the effects of infusion rates on therapeutic and economic outcomes, and new findings may challenge the regular infusion regimen.MethodsFocusing on studies comparing the outcomes of different infusion regimens, the relevant literature was identified by searching PubMed, Web of Science, and Scopus from January 1, 2013 to March 1, 2018. Papers were finally chosen using a PRISMA flowchart.ResultsAntimicrobials with the superiority of prolonged infusion to standard infusion in terms of efficacy and safety include meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin. The strategy of concomitantly reducing total daily dose and prolonging infusion time may cause treatment failure (eg, imipenem). Extended infusion of piperacillin/tazobactam has pharmacoeconomic advantage over standard infusion. Prolonged infusion of voriconazole is inferior to standard infusion because of lower efficacy caused by pharmacokinetic changes. Comparable outcomes following standard infusion and continuous infusion were observed with norvancomycin and nafcillin. Factors determining whether prolonged infusion has a benefit over standard infusion include MIC of bacterial pathogens, bacterial density, diagnosis, disease severity, total daily dose, and renal function.ConclusionTo maximally preserve the effectiveness of current antimicrobials, effective interventions should be implemented to enhance the application of optimal infusion strategies. For reducing nephrotoxicity, prolonged infusion of meropenem is better than conventional infusion in neonates with Gram-negative late-onset sepsis, and continuous infusion of vancomycin is superior to intermittent infusion. For increasing efficacy, prolonged or continuous infusion of time-dependent antimicrobials (eg, meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin) is an optimal choice. Nevertheless, such advantages may only be demonstrated in special clinical circumstances and special populations (eg, patients with a sequential organ failure assessment (SOFA) score≥9, respiratory tract infections, urinary or intra-abdominal infections, or infections caused by less susceptible pathogens would benefit from prolonged infusion of piperacillin/tazobactam).

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Section: Resultsmentioning

confidence: 99%

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Zhu¹,

Zhou²

2018

IDR

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“…Characteristics of the studies included in the meta-analysis are described in Table 1. Among nine total studies, two were RCTs (Lyu et al, 2018;Ammar and Abdalla, 2018), three were quasi-experimental studies (Fahimi et al, 2012;Arnold et al, 2013;Bauer et al, 2013) and four were retrospective cohort studies (Lodise et al, 2007;Lee et al, 2012;Ibrahim et al, 2017;Ahmed et al, 2018). The studies spanned three continents (USA, Asia and Africa).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…None of the studies were funded by pharmaceutical companies. First authors of three trials were contacted for clarification and to complete missing data (Bauer et al, 2013;Ibrahim et al, 2017;Lyu et al, 2018). In two of these three studies, the study authors kindly contributed to data extraction (Bauer et al, 2013;Ibrahim et al, 2017).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nine studies reported data for all-cause mortality as an outcome with different endpoints; three studies reported inhospital mortality (Fahimi et al, 2012;Bauer et al, 2013;Ibrahim et al, 2017), one reported ICU mortality (Ahmed et al, 2018), one reported ventilator-associated pneumonia-related mortality (Ammar and Abdalla, 2018), two studies reported 30day mortality (Lee et al, 2012;Arnold et al, 2013), one reported 14-day mortality (Lodise et al, 2007), and another study reported 28-day mortality (Lyu et al, 2018) (Table 3). There were 126 deaths among 735 patients in the EI arm compared with 195 deaths among 773 patients in the II arm (RD À0.10; 95% CI À0.15 to À0.04).…”

Section: Mortality Outcomementioning

confidence: 99%

“…Four studies (Arnold et al, 2013;Lyu et al, 2018;Ahmed et al, 2018;Ammar and Abdalla, 2018) included clinical success as an outcome. As summarized in Table 3, the clinical success rates were 63.3% (n = 271/428) and 59.4% (n = 269/453) in the EI and II groups, respectively.…”

Section: Clinical Successmentioning

confidence: 99%

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Comparison of extended versus intermittent infusion of antipseudomonal beta-lactams for the treatment of critically ill patients with respiratory infections: A systematic review and meta-analysis

Aboulatta¹,

Sugita

Wakabayashi

et al. 2020

International Journal of Infectious Diseases

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Objectives: Alternative dosing strategies for β-lactamsthe most common antibiotics used to treat critically ill patients with respiratory tract infectionshave been recommended to maximize the duration of exposure and reduce drug resistance. The objective of this study was to evaluate whether extended infusion of antipseudomonal β-lactams improves mortality and clinical efficacy. Methods: Two independent authors identified eligible trials by searching the PubMed, Cochrane Library, Scopus, and ICHUSHI databases, in both English and Japanese, up to June 2019. Data were extracted from both randomized controlled and observational trials comparing extended infusion (!3 h) with intermittent infusion in critically ill patients. The primary outcome was all-cause mortality. Risk differences (RD) and 95% confidential intervals (CI) were calculated using a random-effects model and subgroup analyses were performed. Sensitivity and heterogeneity were also evaluated. Results: Nine studies involving 1508 participants were included in the meta-analysis. Mortality was lower for extended infusion than for intermittent infusion (RD À0.10; 95% CI À0.15 to À0.04). However, no significant between-group differences in clinical success, length of ICU stay, length of hospital stay, and antibiotic duration were observed. Conclusions: Extended infusions of β-lactams were associated with reduced mortality rates but not with clinical success.

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International consensus recommendations for the use of prolonged‐infusion beta‐lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists

Hong,

Downes,

FakhriRavari

et al. 2023

Pharmacotherapy

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Intravenous β‐lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β‐lactams are well established to display time‐dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PIs) can be applied during the administration of intravenous β‐lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of PI β‐lactams developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug‐monitoring considerations, and the use of PI β‐lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β‐lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).

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Selection of piperacillin/tazobactam infusion mode guided by SOFA score in cancer patients with hospital-acquired pneumonia: a randomized controlled study

Cited by 7 publications

References 11 publications

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Optimal infusion rate in antimicrobial therapy: explosion of evidence in the last five years

Comparison of extended versus intermittent infusion of antipseudomonal beta-lactams for the treatment of critically ill patients with respiratory infections: A systematic review and meta-analysis

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