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Use of piperacillin/tazobactam and meropenem in a Danish intensive care unit
Hanna Jernberg1, Marie Warrer Munch1, Maj-Brit Nørregaard Kjær1
1Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet.
Introduction:
Intensive care unit (ICU) patients often have infections, and early empirical treatment with broad-spectrum antibiotics is recommended. As the choice between different agents is not supported by high-certainty evidence and as a part of a larger research programme, we aimed to describe the use of piperacillin/tazobactam (PTZ) and meropenem (MER) in patients in a university hospital ICU in Denmark and the patient outcomes of each of these treatments.
Methods:
We prospectively screened all patients admitted to the general 24-bed ICU at Rigshospitalet for 12 consecutive weeks as from 1 November 2022. Patients were included if they received PTZ or MER during their ICU stay. The primary outcome was 90-day mortality.
Results:
Among 286 patients, 184 (64%) received PTZ and/or MER; 112 (61%) were men, and 161 (88%) received life support. Among these, 80 (43%) received PTZ, 76 (41%) received MER and 28 (15%) received both agents, mainly as empirical treatment. At 90 days, 22 (28%) had died among patients receiving PTZ, 19 (26%) among those receiving MER and eight (29%) among those receiving both agents. At 90 days, 19 cases of a bacterium with new acquired resistance were identified in 17 of the 184 patients (9%) (eight cases among those receiving PTZ, five among those receiving MER, and six among those treated with both agents); vancomycin-resistant enterococci (VRE) accounted for 16 of the 19 cases.
Conclusions:
Most patients in the ICU of a Danish university hospital received antibiotic treatment with PTZ and/or MER, mainly as empirical treatment. Mortality and the occurrence of bacteria with new acquired resistance, mainly VRE, appeared to the same extent in the groups.
Funding:
None.
Trial Registration:
Not relevant.
Insights
Piperacillin/tazobactam (PTZ) and meropenem (MER) are commonly used empirical antibiotics in Danish ICUs. Outcomes, including mortality and new resistant bacteria like VRE, were similar between PTZ and MER treatment groups.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Intensive care unit (ICU) patients frequently develop infections, necessitating prompt empirical antibiotic therapy.
- Current evidence guiding the choice between broad-spectrum antibiotics like piperacillin/tazobactam (PTZ) and meropenem (MER) is limited.
- This study investigated the utilization and patient outcomes associated with PTZ and MER in a Danish university hospital ICU.
Purpose of the Study:
- To describe the empirical use of piperacillin/tazobactam (PTZ) and meropenem (MER) in an ICU setting.
- To compare patient outcomes, including 90-day mortality and the development of acquired antibiotic resistance, between PTZ and MER treatment groups.
Main Methods:
- Prospective screening of all patients admitted to a 24-bed general ICU over 12 weeks.
- Inclusion criteria: patients receiving PTZ or MER during their ICU stay.
- Primary outcome: 90-day mortality. Secondary outcomes included the incidence of new acquired bacterial resistance.
Main Results:
- 184 of 286 ICU patients received PTZ and/or MER, primarily as empirical treatment.
- 90-day mortality rates were similar: 28% for PTZ, 26% for MER, and 29% for both.
- 9% of patients developed new acquired resistance, with vancomycin-resistant enterococci (VRE) being the most common (16 of 19 cases).
Conclusions:
- Piperacillin/tazobactam (PTZ) and meropenem (MER) are widely used empirical antibiotics in this Danish university hospital ICU.
- No significant differences in 90-day mortality or the emergence of new antibiotic-resistant bacteria were observed between the PTZ and MER groups.
- The incidence of vancomycin-resistant enterococci (VRE) warrants continued surveillance and infection control measures.
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