Poster presented at: ID Week 2013, October 2013, San Francisco, California

Andricopulos, Katie

Cox, Elaine G.

Crumby, Ashley S.

Knoderer, Chad A.

Nichols, Kristen R.

Digital Commons @ Butler University

Butler UniversityDigital Commons @ Butler UniversityScholarship and Professional Work – COPHS College of Pharmacy & Health Sciences2013Outcomes of Extended-Infusion Piperacillin/Tazobactam in Pediatric Patients.Kristen R. NicholsButler University, knichols@butler.eduKatie AndricopulosAshley S. CrumbyElaine G. CoxChad A. KnodererButler University, cknodere@butler.eduFollow this and additional works at: http://digitalcommons.butler.edu/cophs_papersPart of the Pediatrics Commons, and the Pharmacy and Pharmaceutical Sciences CommonsThis Presentation is brought to you for free and open access by the College of Pharmacy & Health Sciences at Digital Commons @ Butler University. Ithas been accepted for inclusion in Scholarship and Professional Work – COPHS by an authorized administrator of Digital Commons @ ButlerUniversity. For more information, please contact fgaede@butler.edu.Recommended CitationNichols, Kristen R.; Andricopulos, Katie; Crumby, Ashley S.; Cox, Elaine G.; and Knoderer, Chad A., "Outcomes of Extended-Infusion Piperacillin/Tazobactam in Pediatric Patients." (2013). Scholarship and Professional Work – COPHS. Paper 45.http://digitalcommons.butler.edu/cophs_papers/45TitlesOUTCOMES OF EXTENDED-INFUSION PIPERACILLIN/TAZOBACTAM IN PEDIATRIC PATIENTSKristen R Nichols, PharmD; Katie Andricopulos, PharmD; Ashley S Crumby, PharmD; Elaine G Cox, MD; Chad A Knoderer, PharmDButler University College of Pharmacy and Health Sciences,Riley Hospital for Children at Indiana University Health, and Indiana University School of Medicine, Indianapolis, IndianaBACKGROUND Piperacillin/tazobactam (PT) bactericidal activity associated with fT > MIC Improve fT > MIC through use of continuous or extended infusions (EI) Data in pediatric patients are limited  Courter et al4 simulated extended and continuous infusion PT dosing regimens  PK data from healthy 2 & 12 year olds 337.5 mg/kg/day divided Q8H, infused over 3 hours provides 98% PTA for MICs up to 8 mg/L Since 2011, standard of care for PT dosing at Riley Hospital for Children is 112.5 mg/kg IV Q8H, infused over 4 hours5  Prior to 2011, standard of care was 84.4 mg/kg IVq6H infused over 30 minutes To determine the impact of an extended-infusion PT dosing regimen, as compared to a traditional dosing regimen, on outcomes in children with gram-negative infectionsDesign OutcomesLodise20071-Retrospective 1-center review- Adults with P. aeruginosainfection-Traditional PT vs EIPT-Pts with APACHE-II ≥ 17 had ↓mortality (31.6% vs12.2%, p=0.04) and ↓ LOS (38 vs 21 days, p=0.02)Patel 20092-Retrospective 2-center review-Adults with GNR infection-Traditional PT vs EIPT-Mortality similar between groups (5.7% vs 8.5%, p=0.54)-LOS similarYost20113-Retrospective multi-center review-Adults with GNR infection-EIPT vs non-EI β-lactamcomparators-In-hospital mortality ↓ in EIPT group (9.7 vs 17.9%, p=0.02)-Multivariate analysis; mortality OR 0.43, p=0.05STUDY OBJECTIVEMETHODS Retrospective chart review (April 2010 – March 2012)                                        Inclusion: Inpatients with ages 1 month – 17 years Documented gram-negative infection  Received PT for ≥ 48 hours Exclusion: Prior to study regimen, received another PT dosage regimen or more than one dose of another β-lactam with similar activity Concurrent inadequate treatment of gram positive or fungal pathogens NICU admission RRTTraditional PT84.4 mg/kg IV q6H infused over 30 minEIPT112.5 mg/kg IV q8H infused over 4 hrsPrimary21-day clinical cureSymptomatic resolution, afebrile, WBC normal, negative f/u cultures if availableSecondaryLength of hospital stay (LOS)Duration of PT therapy (DOT)30-day mortality30-day readmission≥ 50% increase in SCr from baselineRESULTSRESULTS 85 patients included (1004 screened)Traditional PT EIPT pn 35 50Male % (n) 60 (21) 42 (21) 0.102Age, mos – median (IQR) 36(17-132) 84(24-132) 0.22Weight, kg – median (IQR) 14.8(9.6-38.6) 22.6(13-37.4) 0.233Cystic Fibrosis % (n) 8.6 (3) 22 (11) 0.1CONCLUSIONREFERENCES In our cohort of patients, extended infusions of piperacillin/tazobactam resulted in outcomes similar to Traditional infusions of piperacillin/tazobactam Next steps: more patients, stratification of illness severity1. Lodise TP, Lomaestro B, Drusano GL.  Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy.  Clin Infect Dis.  2007;44:357-63.  2. Patel GW, Patel N, Lat A, et al.  Outcomes of extended infusion piperacillin/tazobactam for documented Gram-negative infections.  Diagn Microbiol Infect Dis.  2009;64:236-240.3. Yost RJ, Cappelletty DM, et al.  The retrospective cohort of extended-infusion piperacillin-tazobactam(RECEIPT) study : a multicenter study.  2011;31(8):767-765.4. Courter JD, Kuti JL, Girotto JE, Nicolau DP.  Optimizing bactericidal exposures for beta-lactams using prolonged and continuous infusions in the pediatric population.  Pediatr Blood Cancer..  2009; 53:379-85.5. Nichols KR, Knoderer CA,  Cox EG, Kays MB.  System-wide implementation of the use of an extended-infusion piperacillin/tazobactam dosing strategy: feasibility of utilization from a children’s hospital perspectiveTraditional PT EIPT p21-day cure %(n) 85.7 (30) 74 (37) 0.193LOS, daysmedian (IQR) 11 (7-22) 11.5 (5.75-22.5) 0.844DOT, daysmedian (IQR) 8 (4-14) 5 (3-8.25) 0.0730-day readmission 34.3 (12) 32 (16) 0.825↑ SCr 5.7 (2) 10 (5) 0.479 No 30-day mortality in either group#163 Kristen NicholsButler University COPHS 4600 Sunset AvenueIndianapolis, IN 46208317-948-4239knichols@butler.eduTable 1. Clinical outcomes in adults receiving EIPT (4 hour infusion) Table 3. Baseline characteristicsTable 4. Outcome comparison between traditional and EIPTFigure 1. Culture sites in traditional and EIPT groupsTable 2. Evaluated outcomes vs

Outcomes of Extended-Infusion Piperacillin/Tazobactam in Pediatric Patients.

http://digitalcommons.butler.edu/cgi/viewcontent.cgi?article=1056&context=cophs_papers

Outcomes of Extended-Infusion Piperacillin/Tazobactam in Pediatric Patients.

Abstract

Similar works

Full text

Available Versions

Digital Commons @ Butler University