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Published on: August 30, 2018
Documented Use of Piperacillin-Tazobactam and Increased 1-Month Mortality in Healthcare-Associated Intra-Abdominal
Charles Baulier1, Nathalie Zappella1, Nathalie Grall2
1HP, Hôpital Bichat, Department of Anesthesiology and Critical Care Medicine, Paris, France.
Background:
Recent studies have increasingly questioned the efficacy and safety of piperacillin-tazobactam (TZP) in septic patients, particularly those with healthcare-associated intra-abdominal infections (hcIAI). This study assessed clinical outcomes in hcIAI patients receiving microbiologically documented TZP (dTZP) treatment.
Methods:
We conducted a retrospective, propensity score (PS)-matched observational study in the surgical intensive care unit (ICU) of a tertiary university hospital, including adult patients admitted with hcIAI between 1999 and 2019. The primary endpoint was 1-month mortality. Univariate and multivariate logistic regression analyses were performed. A 1:1 PS-matching procedure was applied to reduce baseline imbalances. Sensitivity analyses included inverse probability of treatment weighting (IPTW). Subgroup analyses assessed treatment-effect heterogeneity.
Results:
A total of 454 patients were analyzed. In univariate analysis, despite a higher rate of adequacy in empirical therapy (70%vs. 56%, p = 0.008), patients receiving dTZP had higher 1-month mortality rates (44% vs. 25%, p < 0.001). Multivariate analysis identified dTZP treatment (OR=2.31, 95%CI [1.35-3.95], p = 0.002), SOFA score (OR=1.29, 95%CI [1.20-1.40], p < 0.001), age (OR=1.04, 95%CI [1.02-1.06], p = 0.001), and non-fermenting Gram-negative bacilli isolation (OR=1.89, 95%CI [1.01-3.51], p = 0.045) as independent predictors of 1-month mortality. In the PS-matched cohort, dTZP use remained associated with higher 1-month mortality rates (40% vs. 27%, p = 0.025). However, IPTW analysis did not reach statistical significance, and no mortality signal was identified in patients included after 2010.
Conclusion:
dTZP administration in hcIAI was associated with increased 1-month mortality in most analyses, though sensitivity analyses were not uniformly positive, and residual confounding cannot be excluded.
Insights
Piperacillin-tazobactam (TZP) treatment for healthcare-associated intra-abdominal infections (hcIAI) was linked to higher mortality in septic patients. Further analysis is needed due to potential confounding factors.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Growing concerns exist regarding piperacillin-tazobactam (TZP) efficacy and safety in septic patients, especially with healthcare-associated intra-abdominal infections (hcIAI).
- Clinical outcomes of microbiologically documented TZP (dTZP) treatment in hcIAI patients require thorough assessment.
Purpose of the Study:
- To evaluate the clinical outcomes, specifically 1-month mortality, in patients with hcIAI who received dTZP.
- To investigate the association between dTZP treatment and mortality in a cohort of critically ill patients.
Main Methods:
- A retrospective, propensity score (PS)-matched observational study was conducted in a surgical intensive care unit (ICU) from 1999 to 2019.
- The study included adult patients with hcIAI, with 1-month mortality as the primary endpoint.
- Propensity score matching and inverse probability of treatment weighting (IPTW) were used to control for confounding variables.
Main Results:
- Univariate analysis showed higher 1-month mortality in the dTZP group (44% vs. 25%).
- Multivariate analysis identified dTZP treatment as an independent predictor of mortality (OR=2.31).
- In the PS-matched cohort, dTZP remained associated with increased mortality (40% vs. 27%), although IPTW analysis did not reach statistical significance.
Conclusions:
- dTZP administration in hcIAI patients was generally associated with increased 1-month mortality.
- Sensitivity analyses yielded mixed results, and residual confounding cannot be entirely ruled out.
- No significant mortality signal was observed in patients treated after 2010.
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