학술논문
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
Document Type
Academic Journal
Author
Abdul-Aziz, Mohd H.; Lipman, Jeffrey; Akova, Murat; Bassetti, Matteo; De Waele, Jan J.; Dimopoulos, George; Dulhunty, Joel; Kaukonen, Kirsi-Maija; Koulenti, Despoina; Martin, Claude; Montravers, Philippe; Rello, Jordi; Rhodes, Andrew; Starr, Therese; Wallis, Steven C.; Roberts, Jason A.; Roberts, Jason A.; Lipman, Jeffrey; Starr, Therese; Wallis, Steven C.; Paul, Sanjoy; Ribas, Antonio Margarit; De Waele, Jan J.; De Crop, Luc; Spapen, Herbert; Wauters, Joost; Dugernier, Thierry; Jorens, Philippe; Dapper, Ilse; De Backer, Daniel; Taccone, Fabio S.; Rello, Jordi; Ruano, Laura; Afonso, Elsa; Alvarez-Lerma, Francisco; Gracia-Arnillas, Maria Pilar; Fernández, Francisco; Feijoo, Neus; Bardolet, Neus; Rovira, Assumpta; Garro, Pau; Colon, Diana; Castillo, Carlos; Fernado, Juan; Lopez, Maria Jesus; Fernandez, Jose Luis; Arribas, Ana Maria; Teja, Jose Luis; Ots, Elsa; Montejo, Juan Carlos; Catalan, Mercedes; Prieto, Isidro; Gonzalo, Gloria; Galvan, Beatriz; Blasco, Miguel Angel; Meyer, Estibaliz; Del Nogal, Frutos; Vidaur, Loreto; Sebastian, Rosa; Garde, Pila Marco; del Mar Martin Velasco, Maria; Crespo, Rafael Zaragoza; Esperatti, Mariano; Torres, Antoni; Montravers, Philippe; Baldesi, Olivier; Dupont, Herve; Mahjoub, Yazine; Lasocki, Sigismond; Constantin, Jean Michel; Payen, Jean François; Martin, Claude; Albanese, Jacques; Malledant, Yannick; Pottecher, Julien; Lefrant, Jean-Yves; Jaber, Samir; Joannes-Boyau, Olivier; Orban, Christophe; Ostermann, Marlies; McKenzie, Catherine; Berry, Willaim; Smith, John; Lei, Katie; Rubulotta, Francesca; Gordon, Anthony; Brett, Stephen; Stotz, Martin; Templeton, Maie; Rhodes, Andrew; Ebm, Claudia; Moran, Carl; Kaukonen, Kirsi-Maija; Pettilä, Ville; Dimopoulos, George; Koulenti, Despoina; Xristodoulou, Aglaia; Theodorou, Vassiliki; Kouliatsis, Georgios; Sertaridou, Eleni; Anthopoulos, Georgios; Choutas, George; Rantis, Thanos; Karatzas, Stylianos; Balla, Margarita; Papanikolaou, Metaxia; Myrianthefs, Pavlos; Gavala, Alexandra; Fildisis, Georgios; Koutsoukou, Antonia; Kyriakopoulou, Magdalini; Petrochilou, Kalomoira; Kompoti, Maria; Michalia, Martha; Clouva-Molyvdas, Fillis-Maria; Gkiokas, Georgios; Nikolakopoulos, Fotios; Psychogiou, Vasiliki; Malliotakis, Polychronis; Akoumianaki, Evangelia; Lilitsis, Emmanouil; Koulouras, Vassilios; Nakos, George; Kalogirou, Mihalis; Komnos, Apostolos; Zafeiridis, Tilemachos; Chaintoutis, Christos; Arvaniti, Kostoula; Matamis, Dimitrios; Chaintoutis, Christos; Kydona, Christina; Gritsi-Gerogianni, Nikoleta; Giasnetsova, Tatiana; Giannakou, Maria; Soultati, Ioanna; Chytas, Ilias; Antoniadou, Eleni; Antipa, Elli; Lathyris, Dimitrios; Koukoubani, Triantafyllia; Paraforou, Theoniki; Spiropoulou, Kyriaki; Bekos, Vasileios; Spring, Anna; Kalatzi, Theodora; Nikolaou, Hara; Laskou, Maria; Strouvalis, Ioannis; Aloizos, Stavros; Kapogiannis, Spyridon; Soldatou, Ourania; Bassetti, Matteo; Adembri, Chiara; Villa, Gianluca; Giarratano, Antonio; Raineri, Santi Maurizio; Cortegiani, Andrea; Montalto, Francesca; Strano, Maria Teresa; Ranieri, V. Marco; Sandroni, Claudio; De Pascale, Gennaro; Molin, Alexandre; Pelosi, Paolo; Montagnani, Luca; Urbino, Rosario; Mastromauro, Ilaria; De Rosa, Francesco G.; Ranieri, V. Marco; Cardoso, Teresa; Afonso, Susana; Gonçalves-Pereira, João; Baptista, João Pedro; Akova, Murat; Özveren, Arife
Source
Journal of Antimicrobial Chemotherapy. Jan 01, 2016 71(1):196-207
Subject
Language
English
ISSN
0305-7453
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 β-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.