Implementation of Piperacillin-Tazobactam Continuous Infusions for Critically Ill Patients: A Single-Centre...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Pharmacokinetic variability in critically ill patients can lead to suboptimal antimicrobial concentrations.
• Increasing antimicrobial resistance in nonfermenting gram-negative bacilli (NFGNB) necessitates optimized antibiotic dosing.
• Guidelines recommend prolonged infusion of beta-lactam antibiotics to improve pharmacokinetics/pharmacodynamics.

Purpose of the Study:

• To evaluate the implementation of a continuous infusion piperacillin-tazobactam (P/T) protocol in intensive care units (ICUs).
• To assess secondary outcomes including ICU mortality, length of stay (LOS), and safety incidents.
• To determine the prevalence of NFGNB and their minimum inhibitory concentrations (MICs) for P/T.

Main Methods:

• A single-centre retrospective study of 200 patients receiving P/T in the ICU between October 2020 and October 2022.
• Data collected from digital records and the Critical Care Database.
• Successful implementation defined by meeting at least 6 of 8 predefined criteria.

Main Results:

• The continuous infusion P/T protocol was successfully implemented in 78.0% (156/200) of patients.
• ICU mortality was 20.5% (41/200), with a median LOS of 4.9 days.
• No safety incidents related to the protocol were identified; NFGNB prevalence was 3.1%.

Conclusions:

• Successful implementation of continuous infusion P/T was achieved in the majority of ICU patients.
• Areas for improvement include refining order sets, interprofessional education, and collaboration.
• Continuous infusion P/T represents a viable strategy for optimizing antibiotic therapy in critically ill patients.