Chan Jeannie D, Dellit Timothy H, Lynch John B
1 Department of Pharmacy, Harborview Medical Center, School of Pharmacy, University of Washington, Seattle, WA, USA.
2 Division of Allergy and Infectious Diseases, Department of Medicine, Harborview Medical Center and School of Medicine, University of Washington, Seattle, WA, USA.
J Intensive Care Med. 2018 Feb;33(2):134-141. doi: 10.1177/0885066617708756. Epub 2017 May 10.
We sought to evaluate clinical outcomes of intensive care unit (ICU) patients following a hospital-wide initiative of prolonged piperacillin/tazobactam (PIP/TAZ) infusion.
Retrospective observational study of patients >18 years old who was hospitalized in the ICU receiving PIP/TAZ for >72 hours during the preimplementation (June 1, 2010 to May 31, 2011) and postimplementation (July 7, 2011 to June 30, 2014) periods.
There were 124 and 429 patients who met inclusion criteria with average age of 54.3 and 56.9 years, and average duration of PIP/TAZ therapy was 6.1 ± 2.8 days and 5.9 ± 3.4 days in the pre- and postimplementation period, respectively. Intensive care unit and hospital length of stay (LOS) following initiation of PIP/TAZ were 8.0 ± 8.4 days versus 6.4 ± 6.8 days and 26.3 ± 22.8 days versus 20.4 ± 16.1 days among patients in the pre- and postimplementation periods, respectively. Compared to patients who received intermittent PIP/TAZ infusion, the adjusted difference in ICU and hospital LOS was 0.6 ± 0.8 days (95% confidence interval [CI]: -0.9 to 2.1 days) and 5.6 ± 2.1 days (95% CI: 1.4 - 9.7 days) shorter among patients who received prolonged PIP/TAZ infusion. At hospital discharge, 19 (15.3%) intermittent infusion and 74 (17.2%) prolonged infusion recipients had died. In comparison to intermittent infusion recipients, the adjusted odds ratio for mortality was 1.17 (95% CI: 0.65-2.1) with prolonged infusion.
Our study demonstrated a reduction in hospital LOS with prolonged PIP/TAZ infusion among critically ill patients. Randomized trials are needed to further validate these findings.
我们试图评估在全院范围内延长哌拉西林/他唑巴坦（PIP/TAZ）输注时间这一举措后，重症监护病房（ICU）患者的临床结局。
对在实施前（2010年6月1日至2011年5月31日）和实施后（2011年7月7日至2014年6月30日）期间入住ICU且接受PIP/TAZ治疗超过72小时的18岁以上患者进行回顾性观察研究。
分别有124例和429例患者符合纳入标准，平均年龄分别为54.3岁和56.9岁，实施前和实施后PIP/TAZ治疗的平均持续时间分别为6.1±2.8天和5.9±3.4天。在开始PIP/TAZ治疗后，实施前和实施后患者的ICU住院时间和医院住院时间（LOS）分别为8.0±8.4天和6.4±6.8天，以及26.3±22.8天和20.4±16.1天。与接受间歇性PIP/TAZ输注的患者相比，接受延长PIP/TAZ输注的患者在ICU和医院的LOS调整差异分别缩短了0.6±0.8天（95%置信区间[CI]：-0.9至2.1天）和5.6±2.1天（95%CI：1.4 - 9.7天）。出院时，19例（15.3%）接受间歇性输注和74例（17.2%）接受延长输注的患者死亡。与间歇性输注接受者相比，延长输注的死亡调整比值比为1.17（95%CI：0.65 - 2.1）。
我们的研究表明，在重症患者中延长PIP/TAZ输注时间可缩短医院住院时间。需要进行随机试验以进一步验证这些发现。
