Brunetti Luigi, Poustchi Shirin, Cunningham Daniel, Toscani Michael, Nguyen Joanne, Lim Jeremy, Ding Yilun, Nahass Ronald G
Rutgers University, Piscataway, NJ, USA
Rutgers University, Piscataway, NJ, USA.
Ann Pharmacother. 2015 Jul;49(7):754-60. doi: 10.1177/1060028015579427. Epub 2015 Apr 8.
Current medical center practice allows for the automatic conversion of all piperacillin/tazobactam orders from intermittent to extended infusion (EI).
To compare the clinical and cost impact of empirical extended-infusion piperacillin/tazobactam.
All consecutive patients treated with piperacillin/tazobactam for >48 hours were reviewed for inclusion. Patients were stratified into 2 groups: (1) traditional infusion (TI), preprotocol implementation, and (2) EI, postprotocol implementation. Patient demographics and primary and secondary diagnoses were extracted from the hospital discharge database. All patients were assessed for the primary end point of all cause 14-day in-hospital mortality. Secondary outcomes included length of hospital stay, duration of antibiotic therapy, cost per treatment course, and occurrence of Clostridium difficile infection.
A total of 2150 patients were included (EI = 632; TI = 1518). After adjusting for comorbidity, length of stay, and age, 14-day in-hospital mortality was similar between groups (odds ratio = 1.16; 95% CI = 0.85-1.58; P = 0.37). Length of stay was similar between the EI group versus TI (mean ± SD: 12.5 ± 9.58 days vs 11.8 ± 9.58 days, respectively; P = 0.10) after adjusting for age and Chalson-Deyo comorbidity index. Total cost per treatment course was reduced in the EI group by 13% compared with the TI group ($565.90 ± $257.70 vs $648.30 ± $349.20, respectively; P < 0.0001).
Automatic substitution of EI for TI piperacillin/tazobactam is safe and associated with significant cost savings. EI piperacillin/tazobactam was not associated with a reduction in mortality or length of stay.
当前医疗中心的做法允许将所有哌拉西林/他唑巴坦医嘱从间歇性输注自动转换为延长输注（EI）。
比较经验性延长输注哌拉西林/他唑巴坦的临床和成本影响。
对所有连续接受哌拉西林/他唑巴坦治疗超过48小时的患者进行纳入审查。患者被分为两组：（1）传统输注（TI），方案实施前；（2）EI，方案实施后。从医院出院数据库中提取患者人口统计学信息以及主要和次要诊断。评估所有患者的主要终点为全因14天院内死亡率。次要结局包括住院时间、抗生素治疗持续时间、每个疗程的费用以及艰难梭菌感染的发生率。
共纳入2150例患者（EI组 = 632例；TI组 = 1518例）。在调整合并症、住院时间和年龄后，两组间14天院内死亡率相似（优势比 = 1.16；95%置信区间 = 0.85 - 1.58；P = 0.37）。在调整年龄和查尔森 - 戴约合并症指数后，EI组与TI组的住院时间相似（均值 ± 标准差：分别为12.5 ± 9.58天和11.8 ± 9.58天；P = 0.10）。与TI组相比，EI组每个疗程的总成本降低了13%（分别为565.90 ± 257.70美元和648.30 ± 349.20美元；P < 0.0001）。
将TI哌拉西林/他唑巴坦自动替换为EI是安全的，且可显著节省成本。EI哌拉西林/他唑巴坦与死亡率降低或住院时间缩短无关。
