6533b7dafe1ef96bd126f5f2
RESEARCH PRODUCT
Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort
Mohd H. Abdul-azizJeffrey LipmanMurat AkovaMatteo BassettiJan J. De WaeleGeorge DimopoulosJoel DulhuntyKirsi-maija KaukonenDespoina KoulentiClaude MartinPhilippe MontraversJordi RelloAndrew RhodesTherese StarrSteven C. WallisJason A. RobertsSanjoy PaulAntonio Margarit RibasLuc De CropHerbert SpapenJoost WautersThierry DugernierPhilippe JorensIlse DapperDaniel De BackerFabio S. TacconeLaura RuanoElsa AfonsoFrancisco Alvarez-lermaMaria Pilar Gracia-arnillasFrancisco FernándezNeus FeijooNeus BardoletAssumpta RoviraPau GarroDiana ColonCarlos CastilloJuan FernadoMaria Jesus LopezJose Luis FernandezAna Maria ArribasJose Luis TejaElsa OtsJuan Carlos MontejoMercedes CatalanIsidro PrietoGloria GonzaloBeatriz GalvanMiguel Angel BlascoEstibaliz MeyerFrutos Del NogalLoreto VidaurRosa SebastianPila Marco GardeMaria Del Mar Martin VelascoRafael Zaragoza CrespoMariano EsperattiAntoni TorresOlivier BaldesiHerve DupontYazine MahjoubSigismond LasockiJean Michel ConstantinJean François PayenJacques AlbaneseYannick MalledantJulien PottecherJean-yves LefrantSamir JaberOlivier Joannes-boyauChristophe OrbanMarlies OstermannCatherine MckenzieWillaim BerryJohn SmithKatie LeiFrancesca RubulottaAnthony GordonStephen BrettMartin StotzMaie TempletonClaudia EbmCarl MoranVille PettiläAglaia XristodoulouVassiliki TheodorouGeorgios KouliatsisEleni SertaridouGeorgios AnthopoulosGeorge ChoutasThanos RantisStylianos KaratzasMargarita BallaMetaxia PapanikolaouPavlos MyrianthefsAlexandra GavalaGeorgios FildisisAntonia KoutsoukouMagdalini KyriakopoulouKalomoira PetrochilouMaria KompotiMartha MichaliaFillis-maria Clouva-molyvdasGeorgios GkiokasFotios NikolakopoulosVasiliki PsychogiouPolychronis MalliotakisEvangelia AkoumianakiEmmanouil LilitsisVassilios KoulourasGeorge NakosMihalis KalogirouApostolos KomnosTilemachos ZafeiridisChristos ChaintoutisKostoula ArvanitiDimitrios MatamisChristina KydonaNikoleta Gritsi-gerogianniTatiana GiasnetsovaMaria GiannakouIoanna SoultatiIlias ChytasEleni AntoniadouElli AntipaDimitrios LathyrisTriantafyllia KoukoubaniTheoniki ParaforouKyriaki SpiropoulouVasileios BekosAnna SpringTheodora KalatziHara NikolaouMaria LaskouIoannis StrouvalisStavros AloizosSpyridon KapogiannisOurania SoldatouChiara AdembriGianluca VillaAntonio GiarratanoSanti Maurizio RaineriAndrea CortegianiFrancesca MontaltoMaria Teresa StranoV. Marco RanieriClaudio SandroniGennaro De PascaleAlexandre MolinPaolo PelosiLuca MontagnaniRosario UrbinoIlaria MastromauroFrancesco G. De RosaTeresa CardosoSusana AfonsoJoão Gonçalves-pereiraJoão Pedro BaptistaArife ÖZverensubject
0301 basic medicineMalePenicillanic Acidintensive care unitlaw.inventionthienamycin derivative abdominal infection[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseaseslawcentral nervous system infectioncreatinine clearancePharmacology (medical)Infusions IntravenouProspective StudiesInfusions IntravenousProspective cohort studyTazobactam Drug CombinationAged; Anti-Bacterial Agents; Blood Chemical Analysis; Critical Illness; Female; Humans; Infusions Intravenous; Intensive Care Units; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin Tazobactam Drug Combination; Prospective Studies; Thienamycins; Treatment Outcome; Pharmacology; Microbiology (medical); Pharmacology (medical); Infectious Diseasescritical illneMicrobial Sensitivity TestadultRespiratory infectionclinical trialMiddle Agedcontinuous infusionanalogs and derivativeIntensive care unit3. Good healthAnti-Bacterial Agentsantiinfective agentintravenous drug administrationIntensive Care Units[SDV.MP]Life Sciences [q-bio]/Microbiology and ParasitologyTreatment OutcomeInfectious DiseasesPiperacillin/tazobactammulticenter study (topic)SOFA scoreFemaletreatment outcome AgedIntravenousprospective studyHumanmedicine.drugsurvival rateMicrobiology (medical)medicine.medical_specialtyInfusionspost hoc analysirespiratory tract infectionCritical IllnessAged; Anti-Bacterial Agents; Blood Chemical Analysis; Critical Illness; Female; Humans; Infusions Intravenous; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Penicillanic Acid; Piperacillin; Prospective Studies; Thienamycins; Treatment Outcome; Pharmacology; Pharmacology (medical); Infectious Diseases030106 microbiologybloodstream infectionMicrobial Sensitivity Testsminimum inhibitory concentrationpiperacillin plus tazobactamMeropenemTazobactamArticle03 medical and health sciencescritically ill patientInternal medicineAnti-Bacterial AgentmedicineSequential Organ Failure Assessment ScoreHumansThienamycinsurvival timeblood analysiAgedPiperacillinPharmacologybusiness.industryBlood Chemical AnalysiMeropenemmajor clinical studySurgeryProspective Studiemulticenter studyPharmacology; Pharmacology (medical); Infectious Diseases[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/PharmacologyThienamycinspiperacillin tazobactam drug combinationurinary tract infectionbusinessBlood Chemical AnalysisPiperacillindescription
Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT≥MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving β-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of ≥ 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2016-01-01 |