Continuous/prolonged vs intermittent infusion of piperacillin-tazobactam for critically ill patients

  • Fawaz S & al.
  • BMC Infect Dis
  • 20 Jun 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that continuous/prolonged infusion (C/PI) of piperacillin-tazobactam in critically ill adult patients is associated with improved clinical cure, mortality, and length of hospital stay in comparison to the intermittent infusion (II).

Why this matters

  • Findings warrant more rigorous scientific studies to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy in critically ill patients.

Study design

  • Meta-analysis of 23 studies including 3828 critically ill adult patients (C/PI, n=2197 and II, n=1631).
  • Funding: None disclosed.

Key results

  • C/PI vs II group had significantly higher clinical cure (OR, 1.56; 95% CI, 1.28-1.90; P=.0001) and microbiological success rates (OR, 1.52; 95% CI, 1.10-2.11; P=.01).
  • Mortality rates were lower in patients receiving C/PI compared with patients receiving conventional II (OR, 0.68; 95% CI, 0.55-0.84; P=.0003).
  • Patients receiving C/PI vs those receiving II had a significantly shorter length of hospital stay (mean difference, -1.27; 95% CI, -2.45 to -0.08; P=.04; I2, 65%)
  • No significant difference was observed in adverse events between the two infusion strategies (OR, 0.85; 95%CI, 0.50-1.42; P=.53).

Limitations

  • It is unclear which of the two dosing strategies is most effective as prolonged infusion and continuous infusion were combined and referred to as C/PI.
  • Risk of bias.