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

• DOI: 10.1093/jac/dkv288
• Publication Date: 2015-10-03T20:17:59Z
• Authors: Mohd H. Abdul-Aziz; Jeffrey Lipman; Murat Akova; Matteo Bassetti; Jan J. De Waele; George Dimopoulos; Joel Dulhunty; Kirsi-Maija Kaukonen; Despoina Koulenti; Claude Martin; Philippe Montravers; Jordi Rello; Andrew Rhodes; Therese Starr; Steven C. Wallis; Jason A. Roberts
• Keywords: Piperacillin/tazobactam; Pharmacodynamics; Tazobactam

We utilized the database of Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion intermittent-bolus dosing piperacillin/tazobactam meropenem critically ill using inclusion criteria similar those used previous prospective studies. This was a post hoc analysis prospective, multicentre pharmacokinetic point-prevalence (DALI), which recruited large cohort from 68 ICUs across 10 countries. Of 211 receiving DALI study, 182 met criteria. Overall, 89.0% (162/182) achieved most conservative target 50% fT>MIC (time over unbound or free drug concentration remains above MIC). Decreasing creatinine clearance use prolonged infusion significantly increased PTA for targets. In subgroup who had respiratory infection, β-lactams via demonstrated better 30 day survival when compared with [86.2% (25/29) versus 56.7% (17/30); P = 0.012]. Additionally, SOFA score ≥9, administration by cure [73.3% (11/15) 35.0% (7/20); 0.035] rates 25.0% (5/20); 0.025]. Analysis this dataset has provided additional data on niche benefits patients, particularly infections.