title: Clinical and Economic Impact of Empirical Extended-Infusion Piperacillin-Tazobactam in a Community Medical Center.
abstract: BACKGROUND
  Current medical center practice allows for the automatic conversion of all piperacillin/tazobactam orders from intermittent to extended infusion (EI).
  
  
  OBJECTIVE
  To compare the clinical and cost impact of empirical extended-infusion piperacillin/tazobactam.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Rutgers University, Piscataway, NJ, USA brunetti@pharmacy.rutgers.edu.
authors: Luigi
authors: L
authors: Brunetti
authors: Rutgers University, Piscataway, NJ, USA.
authors: Shirin
authors: S
authors: Poustchi
authors: Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA.
authors: Daniel
authors: D
authors: Cunningham
authors: Rutgers University, Piscataway, NJ, USA.
authors: Michael
authors: M
authors: Toscani
authors: Rutgers University, Piscataway, NJ, USA.
authors: Joanne
authors: J
authors: Nguyen
authors: Rutgers University, Piscataway, NJ, USA.
authors: Jeremy
authors: J
authors: Lim
authors: Rutgers University, Piscataway, NJ, USA.
authors: Yilun
authors: Y
authors: Ding
authors: Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA.
authors: Ronald G
authors: RG
authors: Nahass
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; 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
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: empirical therapy; extended-infusion; pharmacodynamics; piperacillin/tazobactam; stewardship