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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Incidence and Determinants of Piperacillin/Tazobactam-Associated Hypokalemia: A Retrospective Study

Heenam Seo1,2, Eunyoung Kim2

  • 1Department of Pharmacy, Kangbuk Samsung Hospital, Seoul 03181, Korea.

Antibiotics (Basel, Switzerland)
|August 26, 2022
PubMed

Insights

Piperacillin/tazobactam (TZP) can cause severe hypokalemia in patients. Older age, female sex, longer treatment duration, and higher doses increase risk, while higher baseline potassium levels are protective. Monitoring is crucial.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Infectious Diseases

Background:

  • Piperacillin/tazobactam (TZP) is a critical broad-spectrum antibiotic for moderate-to-severe infections, often used as a carbapenem alternative.
  • Severe hypokalemia is a known but infrequently studied adverse effect associated with TZP therapy.
  • Limited research exists on the incidence and specific risk factors for TZP-associated hypokalemia (TAH).

Purpose of the Study:

  • To determine the incidence of TZP-associated hypokalemia (TAH) in hospitalized adult patients.
  • To identify independent risk factors associated with the development of TAH.
  • To understand the timing of TAH onset during TZP treatment.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of 713 hospitalized adult patients receiving TZP between January 2015 and December 2017.
  • Multivariate logistic regression analysis to identify risk factors for TAH.

Main Results:

  • The incidence of TAH was 13.9% among the studied patients.
  • Independent risk factors for TAH included older age (OR 1.03), female sex (OR 1.88), longer TZP duration (OR 1.08), and higher daily TZP dose (OR 1.10).
  • Higher baseline serum potassium levels were associated with a lower risk of TAH (OR 0.13), with a median onset time of 4 days.

Conclusions:

  • TAH is a significant concern, affecting nearly 14% of patients in this cohort.
  • Specific patient demographics and treatment parameters (age, sex, duration, dose) predict TAH development.
  • Close monitoring of serum potassium, particularly early in TZP therapy, is essential for prevention.
Keywords:
electrolyte disorderhypokalemiaincidencepiperacillin/tazobactamrisk factor

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