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Implementation of Piperacillin-Tazobactam Continuous Infusions for Critically Ill Patients: A Single-Centre
Kylie Landry1, Meghan MacKenzie2, Sarah Burgess3
1, BScPharm, ACPR, is a Clinical Pharmacist - Internal Medicine and Critical Care with the Pharmacy Department, Nova Scotia Health, Central Zone, Halifax, Nova Scotia.
Background:
In critically ill patients, pharmacokinetic variability can lead to inadequate antimicrobial concentrations. Antimicrobial resistance to β-lactam antibiotics is increasing among the nonfermenting gram-negative bacilli (NFGNB). Current guidelines recommend optimizing β-lactam pharmacokinetics/pharmacodynamics with prolonged infusion of these antibiotics. In 2019, a protocol for continuous infusion of piperacillin-tazobactam (P/T) was implemented in 2 intensive care units (ICUs) as a quality improvement initiative.
Objectives:
The primary objective was to describe and evaluate implementation of the practice change to continuous infusion of P/T. The secondary objectives were to describe ICU mortality and length of stay (LOS), identify safety incidents related to the protocol, and determine the prevalence of NFGNB and associated minimum inhibitory concentrations of P/T.
Methods:
This single-centre retrospective study involved a convenience sample of 200 patients who received 2 or more doses of P/T during an ICU admission between October 2020 and October 2022. Data on drug administration, characteristics of the hospital stay, and patient outcomes were collected from patients' digital records and the Critical Care Database of the study institution. Eight criteria for successful implementation of the protocol were established, with implementation deemed successful if at least 6 of these criteria were met.
Results:
Implementation of the continuous-infusion protocol was successful for 156 (78.0%) of the 200 ICU patients, 41 (20.5%) of the patients died during the ICU admission, and the median LOS in the ICU was 4.9 (interquartile range 2.4-10.7) days. No safety incidents were identified. The prevalence of NFGNB was 3.1% for all ICU patients over the 2-year study period.
Conclusions:
Implementation of the continuous-infusion protocol was successful in most patients. Areas for improvement include editing the order set, providing interprofessional education, and enhancing interprofessional collaboration.
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