Landry Kylie, MacKenzie Meghan, Burgess Sarah, Bonnar Paul, Shabi Yahya, Patriquin Glenn, Holland Karolynn, Eichhorn Volker
, BScPharm, ACPR, is a Clinical Pharmacist - Internal Medicine and Critical Care with the Pharmacy Department, Nova Scotia Health, Central Zone, Halifax, Nova Scotia.
, BScPharm, ACPR, PharmD, is the Clinical Coordinator Critical Care, Emergency Medicine, with the Pharmacy Department, Nova Scotia Health, Central Zone, and an Assistant Professor, College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
Can J Hosp Pharm. 2025 Aug 13;78(3):e3710. doi: 10.4212/cjhp.3710. eCollection 2025.
In critically ill patients, pharmacokinetic variability can lead to inadequate antimicrobial concentrations. Antimicrobial resistance to β-lactam antibiotics is increasing among the nonfermenting gram-negative bacilli (NFGNB). Current guidelines recommend optimizing β-lactam pharmacokinetics/pharmacodynamics with prolonged infusion of these antibiotics. In 2019, a protocol for continuous infusion of piperacillin-tazobactam (P/T) was implemented in 2 intensive care units (ICUs) as a quality improvement initiative.
The primary objective was to describe and evaluate implementation of the practice change to continuous infusion of P/T. The secondary objectives were to describe ICU mortality and length of stay (LOS), identify safety incidents related to the protocol, and determine the prevalence of NFGNB and associated minimum inhibitory concentrations of P/T.
This single-centre retrospective study involved a convenience sample of 200 patients who received 2 or more doses of P/T during an ICU admission between October 2020 and October 2022. Data on drug administration, characteristics of the hospital stay, and patient outcomes were collected from patients' digital records and the Critical Care Database of the study institution. Eight criteria for successful implementation of the protocol were established, with implementation deemed successful if at least 6 of these criteria were met.
Implementation of the continuous-infusion protocol was successful for 156 (78.0%) of the 200 ICU patients, 41 (20.5%) of the patients died during the ICU admission, and the median LOS in the ICU was 4.9 (interquartile range 2.4-10.7) days. No safety incidents were identified. The prevalence of NFGNB was 3.1% for all ICU patients over the 2-year study period.
Implementation of the continuous-infusion protocol was successful in most patients. Areas for improvement include editing the order set, providing interprofessional education, and enhancing interprofessional collaboration.
在重症患者中，药代动力学变异性可能导致抗菌药物浓度不足。非发酵革兰氏阴性杆菌（NFGNB）对β-内酰胺类抗生素的耐药性正在增加。当前指南建议通过延长这些抗生素的输注时间来优化β-内酰胺类药物的药代动力学/药效学。2019年，作为一项质量改进举措，在2个重症监护病房（ICU）实施了哌拉西林-他唑巴坦（P/T）持续输注方案。
主要目的是描述和评估P/T持续输注这一实践改变的实施情况。次要目的是描述ICU死亡率和住院时间（LOS），识别与该方案相关的安全事件，并确定NFGNB的患病率以及P/T的相关最低抑菌浓度。
这项单中心回顾性研究纳入了一个便利样本，包括200例在2020年10月至2022年10月期间入住ICU期间接受2剂或更多剂P/T的患者。从患者的数字记录和研究机构的重症监护数据库中收集了药物给药、住院特征和患者结局的数据。制定了该方案成功实施的八项标准，如果满足至少六项这些标准，则认为实施成功。
200例ICU患者中有156例（78.0%）成功实施了持续输注方案，41例（20.5%）患者在ICU住院期间死亡，ICU的中位住院时间为4.9天（四分位间距2.4 - 10.7天）。未识别到安全事件。在为期2年的研究期间，所有ICU患者中NFGNB的患病率为3.1%。
大多数患者成功实施了持续输注方案。改进领域包括编辑医嘱集、提供跨专业教育以及加强跨专业协作。
