Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort
- Authors: Abdul-Aziz M.H.; Lipman J.; Akova M.; Bassetti M.; De Waele J.J.; Dimopoulos G.; Dulhunty J.; Kaukonen K.-M.; Koulenti D.; Martin C.; Montravers P.; Rello J.; Rhodes A.; Starr T.; Wallis S.C.; Roberts J.A.; Paul S.; Ribas A.M.; De Crop L.D.; Spapen H.; Wauters J.; Dugernier T.; Jorens P.; Dapper I.; De Backer D.D.; Taccone F.S.; Ruano L.; Afonso E.; Alvarez-Lerma F.; Gracia-Arnillas M.P.; Fernandez F.; Feijoo N.; Bardolet N.; Rovira A.; Garro P.; Colon D.; Castillo C.; Fernado J.; Lopez M.J.; Fernandez J.L.; Arribas A.M.; Teja J.L.; Ots E.; Montejo J.C.; Catalan M.; Prieto I.; Gonzalo G.; Galvan B.; Blasco M.A.; Meyer E.; Nogal F.D.; Vidaur L.; Sebastian R.; Garde P.M.; Velasco M.M.M.; Crespo R.Z.; Esperatti M.; Torres A.; Baldesi O.; Dupont H.; Mahjoub Y.; Lasocki S.; Constantin J.M.; Payen J.C.; Albanese J.; Malledant Y.; Pottecher J.; Lefrant J.-Y.; Jaber S.; Joannes-Boyau O.; Orban C.; Ostermann M.; McKenzie C.; Berry W.; Smith J.; Lei K.; Rubulotta F.; Gordon A.; Brett S.; Stotz M.; Templeton M.; Ebm C.; Moran C.; Pettila V.; Xristodoulou A.; Theodorou V.; Kouliatsis G.; Sertaridou E.; Anthopoulos G.; Choutas G.; Rantis T.; Karatzas S.; Balla M.; Papanikolaou M.; Myrianthefs P.; Gavala A.; Fildisis G.; Koutsoukou A.; Kyriakopoulou M.; Petrochilou K.; Kompoti M.; Michalia M.; Clouva-Molyvdas F.-M.; Gkiokas G.; Nikolakopoulos F.; Psychogiou V.; Malliotakis P.; Akoumianaki E.; Lilitsis E.; Koulouras V.; Nakos G.; Kalogirou M.; Komnos A.; Zafeiridis T.; Chaintoutis C.; Arvaniti K.; Matamis D.; Kydona C.; Gritsi-Gerogianni N.; Giasnetsova T.; Giannakou M.; Soultati I.; Chytas I.; Antoniadou E.; Antipa E.; Lathyris D.; Koukoubani T.; Paraforou T.; Spiropoulou K.; Bekos V.; Spring A.; Kalatzi T.; Nikolaou H.; Laskou M.; Strouvalis I.; Aloizos S.; Kapogiannis S.; Soldatou O.; Adembri C.; Villa G.; Giarratano A.; Raineri S.M.; Cortegiani A.; Montalto F.; Strano M.T.; Marco Ranieri V.; Sandroni C.; De Pascale G.D.; Molin A.; Pelosi P.; Montagnani L.; Urbino R.; Mastromauro I.; De Rosa F.G.; Cardoso T.; Afonso S.; Goncalves-Pereira J.; Baptista J.P.; Ozveren A.
- Publication year: 2016
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/381627
Abstract
Objectives:We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies.Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries.Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT(> MIC) (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving beta-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of >= 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025].Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections.