title: Outcomes of an extended-infusion piperacillin-tazobactam protocol implementation in a community teaching hospital adult intensive care unit.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the outcome differences between patients receiving piperacillin-tazobactam pre- and post-implementation of an extended infusion dosing protocol in a community teaching hospital adult intensive care unit.
  
  
  METHODS
  On December 19th, 2011, extended infusion dosing of piperacillin-tazobactam was implemented at St. John's Hospital's intensive and cardiac care units (ICU/CCU) following IRB-approval. This is a historical case-control cohort study involving review of electronic medical charts of patients who received traditional or extended infusion therapy. Data was collected for patients that received piperacillin-tazobactam in the ICU/CCU from December 19th, 2010 through March 19th, 2011 for traditional infusion and from December 19th, 2011 through March 19th, 2012 for extended infusion. Primary endpoints were ICU/CCU mortality at discharge and length of stay.
  
  
  RESULTS
  The study included 113 patients with 52 in the traditional-infusion group and 61 extended-infusion group. There was no statistically significant difference in the primary end-point of ICU/CCU mortality between the two groups (14.8% vs. 21.1%; p = 0.374). In the extended infusion group, there was a shorter length of ICU and CCU stay (8.32 vs. 12.06 days; p = 0.025) and shorter length of hospital stay (11.32 vs. 19.7 days; p = 0.006). The extended-infusion group showed a decrease in cost of therapy that was statistically significant ($120.21 vs. $155.17; p = 0.035). Adverse drug effects did not differ between the two study groups.
  
  
  CONCLUSIONS
  This study showed that treatment with extended-infusion piperacillin-tazobactam therapy improved patient outcomes while maintaining patient safety and decreasing costs.
authors.affiliation: PGY1 Pharmacy Practice Resident, St. John's Hospital, Springfield, Illinois. pschmees@gmail.com.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Schmees
authors.affiliation: Division of Infectious Disease Clinical Pharmacist, Southern Illinois University at Edwardsville, Edwardsville, IL.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Bergman
authors.affiliation: Emergency Department Clinical Staff Pharmacist, St. John's Hospital, Springfield, Illinois.
authors.forename: Brandi D
authors.initials: BD
authors.lastname: Strader
authors.affiliation: Clinical Staff Pharmacist, St. John's Hospital, Springfield, Illinois.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Metzke
authors.affiliation: Clinical Staff Pharmacist, St. John's Hospital, Springfield, Illinois.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pointer
authors.affiliation: Emergency Department Clinical Staff Pharmacist, St. John's Hospital, Springfield, Illinois.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Valenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D005260:Female; D006764:Hospitals, Community / Q000379:methods*; D006784:Hospitals, Teaching / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin