Department of Pharmacy, NYU Langone Health, New York, NY, USA.
Department of Pharmacy, NYU Langone Health -Brooklyn, Brooklyn, NY, USA.
J Clin Pharm Ther. 2021 Apr;46(2):373-381. doi: 10.1111/jcpt.13291. Epub 2020 Oct 17.
Nationwide shortages of small-volume parenteral solutions (SVPS) compelled hospitals to develop strategies including the use of intravenous push (IVP) administration of antibiotics to reserve SVPS for absolute necessities. It is unknown if administration of beta-lactam antibiotics (BL) via IVP results in worse clinical outcomes compared to intravenous piggyback (IVPB) due to the potential inability to achieve pharmacodynamic targets.
Our health-system implemented a mandatory IVP action plan for BL from October 2017 to September 2018. This was a retrospective study of adult patients with GNB who received empiric therapy with IVPB (30 minutes) or IVP (5 minutes) cefepime (FEP) or meropenem (MEM) for at least 2 days. Endpoints included clinical response, microbiological clearance and mortality. All data are presented as n (%) or median (interquartile range).
The final cohort included 213 patients (IVPB n = 105, IVP n = 108). The primary source of bacteremia was urinary, with Escherichia coli being the primary pathogen. Escalation of therapy was similar between groups (15 [14%] vs 11 [10%], P = .36) at a median of 3 days (P = .68). No significant differences were observed in any secondary endpoints including microbiological clearance, bacteremia recurrence, time to defervescence, WBC normalization, vasopressor duration or in-hospital mortality.
Our findings suggest no differences in clinical response with the use of IVP compared to IVPB FEP and MEM for treatment of GNB. This form of administration may be considered as a fluid conservation strategy in times of shortage.
全国范围内小容量肠外溶液（SVPS）短缺，迫使医院制定策略，包括使用静脉推注（IVP）给予抗生素，将 SVPS 保留给绝对必要的情况。由于潜在的无法达到药效学目标，通过 IVP 给予β-内酰胺类抗生素（BL）是否会导致比静脉滴注（IVPB）更差的临床结果尚不清楚。
我们的医疗系统从 2017 年 10 月至 2018 年 9 月实施了 BL 的强制性 IVP 行动计划。这是一项回顾性研究，纳入了接受至少 2 天 IVPB（30 分钟）或 IVP（5 分钟）头孢吡肟（FEP）或美罗培南（MEM）经验性治疗的 GNB 成年患者。终点包括临床反应、微生物清除率和死亡率。所有数据均以 n（%）或中位数（四分位距）表示。
最终队列纳入了 213 例患者（IVPB n=105，IVP n=108）。菌血症的主要来源是尿源性，主要病原体是大肠埃希菌。两组间治疗升级的比例相似（15 [14%] vs 11 [10%]，P=0.36），中位数为 3 天（P=0.68）。在任何次要终点方面，如微生物清除率、菌血症复发、退热时间、白细胞计数恢复正常、血管加压药持续时间或住院死亡率，均未观察到显著差异。
我们的研究结果表明，与 IVPB FEP 和 MEM 治疗 GNB 相比，IVP 在临床反应方面没有差异。在短缺时期，这种给药方式可以被视为一种液体保留策略。
