278. Clinical Outcome of Piperacillin/tazobactam Extended Infusion Compare to Standard Infusion in Intensive Care Unit Patients with Documented Infections
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Piperacillin/tazobactam (PT) exhibits a time-dependent pharmacodynamic profile in which efficacy is determined by time drug concentration exceeds minimum inhibitory concentrations.  Administering PT as a 4-hour extended infusion (EI) instead of a 30-minute standard infusion (SI) maintains serum concentration in excess of the MIC for a longer period of time.  In this study, clinical outcome of PT EI vs. SI in intensive care unit (ICU) patients with documented infections were evaluated.

Methods: 

Records of patients ≥18 years old who received PT for microbiologically confirmed infections were reviewed retrospectively.  Patients who received PT EI were compared to a cohort of PT SI patients matched for age, gender, and APACHE II score. Exclusion criteria were receipt of PT for ≤48 hours, no identifiable pathogen, and creatinine clearance ≤30 ml/min. Clinical/microbiological outcomes, duration of therapy (DOT), and hospital length of stay (LOS) were compared between groups.

Results: 

A total of 101 EI patients (Jan-Dec, 2009) and 73 SI patients (Jan 2010-Mar 2011) were reviewed.  Baseline characteristics (age, gender & APACHE II scores) were similar between groups, except more EI patients were admitted to the medical ICU (51% vs. 29%, p = 0.005). The most common types of infection for both groups were pneumonia and urinary tract infection caused by P. aeruginosa and K. pneumoniae. No significant difference was observed in mortality rate (16% SI vs. 22% EI, p = 0.441) or hospital LOS (22 days SI vs. 24 days EI, p = 0.139) between groups.  While more patients clinically improved within 72 hours of PT in the SI group (60% vs. 37%, p = 0.002), microbiologic eradication occurred in more EI patients (42% vs. 29%, p = 0.110).  No adverse drug event was reported in EI group.

Conclusion: 

There was no statistical significant difference in mortality or hospital LOS between groups.  Although more SI patients had clinical improvement within 72 hours, this might be confounded by the types of ICU patients.  There was a trend toward higher microbiologic eradication rate in EI group.  All patients tolerated PT EI without adverse events.  The EI strategy was well accepted by ICU nurses. Hence, PT EI is feasible in a large urban teaching facility as an additional method to preserve antibiotics.


Subject Category: A. Antimicrobial agents and Resistance

Connie Lio, PharmD1, Philip Chung, PharmD1, Julie Chen, PharmD1, Jalpa Sojitra, RPh1, Belinda Ostrowsky, MD, MPH2 and Yi Guo, PharmD1, (1)Pharmacy, Montefiore Medical Center, Bronx, NY, (2)Infectious Diseases, Montefiore Medical Center, Bronx, NY

Disclosures:

C. Lio, None

P. Chung, None

J. Chen, None

J. Sojitra, None

B. Ostrowsky, None

Y. Guo, None

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