title: Extended-Infusion versus standard-infusion piperacillin-tazobactam for sepsis syndromes at a tertiary medical center.
abstract: Piperacillin-tazobactam (PTZ) is frequently used as empirical and targeted therapy for Gram-negative sepsis. Time-dependent killing properties of PTZ support the use of extended-infusion (EI) dosing; however, studies have shown inconsistent benefits of EI PTZ treatment on clinical outcomes. We performed a retrospective cohort study of adult patients who received EI PTZ treatment and historical controls who received standard-infusion (SI) PTZ treatment for presumed sepsis syndromes. Data on mortality rates, clinical outcomes, length of stay (LOS), and disease severity were obtained. A total of 843 patients (662 with EI treatment and 181 with SI treatment) were available for analysis. Baseline characteristics of the two groups were similar, except for fewer female patients receiving EI treatment. No significant differences between the EI and SI groups in inpatient mortality rates (10.9% versus 13.8%; P = 0.282), overall LOS (10 versus 12 days; P = 0.171), intensive care unit (ICU) LOS (7 versus 6 days; P = 0.061), or clinical failure rates (18.4% versus 19.9%; P = 0.756) were observed. However, the duration of PTZ therapy was shorter in the EI group (5 versus 6 days; P < 0.001). Among ICU patients, no significant differences in outcomes between the EI and SI groups were observed. Patients with urinary or intra-abdominal infections had lower mortality and clinical failure rates when receiving EI PTZ treatment. We did not observe significant differences in inpatient mortality rates, overall LOS, ICU LOS, or clinical failure rates between patients receiving EI PTZ treatment and patients receiving SI PTZ treatment. Patients receiving EI PTZ treatment had a shorter duration of PTZ therapy than did patients receiving SI treatment, and EI dosing may provide cost savings to hospitals.
authors.affiliation: Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA scott.r.cutro@gmail.com.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Cutro
authors.affiliation: Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Holzman
authors.affiliation: Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Dubrovskaya
authors.affiliation: Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.
authors.forename: Xian Jie Cindy
authors.initials: XJ
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.
authors.forename: Tania
authors.initials: T
authors.lastname: Ahuja
authors.affiliation: Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Scipione
authors.affiliation: Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Papadopoulos
authors.affiliation: Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phillips
authors.affiliation: Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA.
authors.forename: Sapna A
authors.initials: SA
authors.lastname: Mehta
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D007902:Length of Stay / Q000191:economics; D008297:Male; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010878:Piperacillin / Q000191:economics / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D013577:Syndrome; D063128:Tertiary Health Care / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin