title: Antimicrobial Monotherapy versus Combination Therapy for the Treatment of Complicated Intra-Abdominal Infections.
abstract: It is unknown if β-lactam monotherapy is sufficient for complicated intra-abdominal infections or if broader coverage is required, such as with vancomycin. This study sought to determine the clinical outcomes of piperacillin/tazobactam (PIP/TAZ) monotherapy compared to combination therapy with vancomycin and PIP/TAZ for complicated intra-abdominal infections among patients within a surgical intensive care unit (ICU).
  
  
  
  Retrospective cohort study.
  
  
  
  Three surgical ICUs at a tertiary academic medical center.
  
  
  
  Four hundred seventeen patients with a secondary peritonitis identified by International Classification of Diseases, Ninth Revision codes who received either PIP/TAZ monotherapy (228 patients) or PIP/TAZ and vancomycin combination therapy (189 patients).
  
  
  
  The primary outcome was day 28 clinical cure; secondary outcomes included day 7 clinical cure, length of stay (LOS), and mortality. There were no statistically significant differences between the monotherapy and combination therapy groups with respect to day 28 clinical cure (33.9% vs 25.5%, p=0.064), day 7 clinical cure (23.6% vs 17.6%, p=0.14), or 28-day mortality (7% vs 7.9%, p=0.72). LOS in the ICU was significantly shorter in the monotherapy group (6 days) compared with the combination therapy group (7 days; p=0.04); however, hospital LOS was not significantly different.
  
  
  
  No difference was observed in clinical cure rates at day 28 or day 7 between those who received PIP/TAZ monotherapy compared to PIP/TAZ and vancomycin combination therapy.
authors.affiliation: Department of Pharmacy Practice, University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Petite
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Seth R
authors.identifier: 0000-0002-1288-1242
authors.initials: SR
authors.lastname: Bauer
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Bollinger
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Ahrens
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Harinstein
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D014640:Vancomycin; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: critical care; infectious disease; vancomycin