Piperacillin-tazobactam for Pseudomonas aeruginosa infection:: Clinical implications of an extended-infusion dosing strategy
Piperacillin-tazobactam for Pseudomonas aeruginosa infection:: Clinical implications of an extended-infusion dosing strategy
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DOI：
10.1086/510590
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发表时间：
2007-02-01
影响因子：
11.8
通讯作者：
Drusano, George L.
中科院分区：
文献类型：
--
作者：
Lodise, Thomas P., Jr.;Lomaestro, Ben;Drusano, George L.
背景瑞拉西林-他唑巴坦常用于治疗重症患者的铜绿假单胞菌感染。为了改善临床结果，使用Monte Carlo模拟设计了哌拉西林他唑巴坦治疗的延长输注给药方案，并在奥尔巴尼医学中心（奥尔巴尼，纽约）的临床实践中采用.本研究评价了哌拉西林他唑巴坦延长输注治疗铜绿假单胞菌感染危重患者的临床意义。我们对2000年1月至2004年6月期间接受哌拉西林-他唑巴坦治疗对哌拉西林-他唑巴坦敏感的铜绿假单胞菌感染的患者进行了一项队列研究。在2002年2月之前，所有患者均接受间歇性输注哌拉西林-他唑巴坦（每4或6 h静脉输注3.375 g，持续30 min）;此后，所有患者均接受延长输注哌拉西林-他唑巴坦（每8 h静脉输注3.375 g，持续4 h）。收集人口统计学特征、疾病严重程度和微生物学方面的数据，并比较两组之间的结果。两个研究组共194例患者：102例患者接受哌拉西林-他唑巴坦延长输注，92例患者接受哌拉西林-他唑巴坦间歇输注。两组之间的基线临床特征无差异。在急性生理和慢性健康评估- II评分>= 17的患者中，接受延长输液治疗的患者的14天死亡率显著低于接受间歇输液治疗的患者（分别为12.2%和31.6%; P = 0.04），而接受延长治疗的患者，在采集样本进行培养后的住院时间中位数明显较短，输注治疗组与间歇性输注治疗组相比（21天对38天; P。02）.结论。这些结果表明，延长输注哌拉西林-他唑巴坦治疗是间歇输注哌拉西林-他唑巴坦治疗的合适替代方案，并且它们强烈表明，通过对铜绿假单胞菌感染的危重患者给予延长输注哌拉西林-他唑巴坦治疗可以实现改善的结局.
Background. Piperacillin- tazobactam is frequently used to treat Pseudomonas aeruginosa infections in critically ill patients. In an effort to improve clinical outcomes, an extended- infusion dosing scheme for piperacillintazobactam therapy was devised using a Monte Carlo simulation and was adopted into clinical practice at Albany Medical Center ( Albany, New York). This study evaluates the clinical implications of extended infusion of piperacillintazobactam therapy for critically ill patients with P. aeruginosa infection.Methods. We performed a cohort study of patients who received piperacillin- tazobactam therapy for a P. aeruginosa infection that was susceptible to piperacillin- tazobactam during the period January 2000 - June 2004. Prior to February 2002, all patients received intermittent infusions of piperacillin- tazobactam ( 3.375 g intravenously for 30 min every 4 or 6 h); after this time, all patients received extended infusions of piperacillin- tazobactam ( 3.375 g intravenously for 4 h every 8 h). Data on demographic characteristics, disease severity, and microbiology were collected, and outcomes were compared between groups.Results. A total of 194 patients comprised the 2 study groups: 102 patients received extended infusions of piperacillin- tazobactam, and 92 patients received intermittent infusions of piperacillin- tazobactam. No differences in baseline clinical characteristics were noted between the 2 groups. Among patients with Acute Physiological and Chronic Health Evaluation - II scores >= 17, 14- day mortality rate was significantly lower among patients who received extended- infusion therapy than among patients who received intermittent- infusion therapy ( 12.2% vs. 31.6%, respectively; P = .04), and median duration of hospital stay after collection of samples for culture was significantly shorter for patients who received extended- infusion therapy than for patients who received intermittent- infusion therapy ( 21 days vs. 38 days; P . 02).Conclusions. These results indicate that extended- infusion piperacillin- tazobactam therapy is a suitable alternative to intermittent- infusion piperacillin- tazobactam therapy, and they strongly suggest that improved outcomes may be realized by administering extended- infusion piperacillin- tazobactam therapy to critically ill patients with P. aeruginosa infection.