Lodise Thomas P, Lomaestro Ben, Drusano George L
Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208, USA.
Clin Infect Dis. 2007 Feb 1;44(3):357-63. doi: 10.1086/510590. Epub 2007 Jan 2.
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 piperacillin-tazobactam 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 piperacillin-tazobactam therapy for critically ill patients with P. aeruginosa infection.
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.
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 > or =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.
哌拉西林-他唑巴坦常用于治疗重症患者的铜绿假单胞菌感染。为改善临床疗效，通过蒙特卡洛模拟设计了一种哌拉西林-他唑巴坦延长输注给药方案，并在奥尔巴尼医疗中心（纽约州奥尔巴尼）应用于临床实践。本研究评估了哌拉西林-他唑巴坦延长输注疗法对重症铜绿假单胞菌感染患者的临床意义。
我们对2000年1月至2004年6月期间接受哌拉西林-他唑巴坦治疗且感染的铜绿假单胞菌对哌拉西林-他唑巴坦敏感的患者进行了一项队列研究。2002年2月之前，所有患者接受哌拉西林-他唑巴坦间歇输注（3.375 g静脉滴注，每4或6小时一次，持续30分钟）；此后，所有患者接受哌拉西林-他唑巴坦延长输注（3.375 g静脉滴注，每8小时一次，持续4小时）。收集患者的人口统计学特征、疾病严重程度和微生物学数据，并比较两组的结局。
两个研究组共有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。两组患者的基线临床特征无差异。在急性生理与慢性健康状况评分II≥17分的患者中，接受延长输注疗法的患者14天死亡率显著低于接受间歇输注疗法的患者（分别为12.2%和31.6%；P=0.04），且接受延长输注疗法的患者在采集样本进行培养后的住院中位时间显著短于接受间歇输注疗法的患者（21天对38天；P=0.02）。
这些结果表明，哌拉西林-他唑巴坦延长输注疗法是哌拉西林-他唑巴坦间歇输注疗法的合适替代方案，并且强烈提示，对重症铜绿假单胞菌感染患者给予哌拉西林-他唑巴坦延长输注疗法可能会改善结局。
