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Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically-ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy.
Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager.
Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (OR 1.56, 95% C.I 1.28-1.90, P = 0 .0001), lower mortality rates (OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003), higher microbiological success rates (OR 1.52, 95% C.I 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (OR -1.27, 95% C.I -2.45—0.08, P = 0.04) in critically ill patients.
Conclusion: There is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. Therefore, this alternative infusion strategy could be recommended in clinical practice.
Keywords
Critically ill patients, continuous infusions, prolonged infusion, intermittent infusion and clinical efficacy
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 09 Jun, 2020
Editorial decision: Accept
On 09 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 08 Jun, 2020
Review #1 received
Received 07 Jun, 2020
Reviewer #1 agreed
On 10 May, 2020
Editor assigned
On 08 May, 2020
Reviewers invited
Invitations sent on 08 May, 2020
Editor invited
On 07 May, 2020
Submission checks complete
On 21 Feb, 2020
Version 1
Posted 25 Feb, 2020
No comments provided
Editorial decision: Major revision
On 07 Apr, 2020
Review #3 received
Received 07 Apr, 2020
Review #2 received
Received 01 Apr, 2020
Reviewer #3 agreed
On 27 Mar, 2020
Reviewer #2 agreed
On 22 Mar, 2020
Review #1 received
Received 22 Mar, 2020
Reviewer #1 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
First submitted
On 20 Feb, 2020
Editor assigned
On 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
Metrics
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Subject Areas
Infectious Diseases
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 09 Jun, 2020
Editorial decision: Accept
On 09 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 08 Jun, 2020
Review #1 received
Received 07 Jun, 2020
Reviewer #1 agreed
On 10 May, 2020
Editor assigned
On 08 May, 2020
Reviewers invited
Invitations sent on 08 May, 2020
Editor invited
On 07 May, 2020
Submission checks complete
On 21 Feb, 2020
Version 1
Posted 25 Feb, 2020
No comments provided
Editorial decision: Major revision
On 07 Apr, 2020
Review #3 received
Received 07 Apr, 2020
Review #2 received
Received 01 Apr, 2020
Reviewer #3 agreed
On 27 Mar, 2020
Reviewer #2 agreed
On 22 Mar, 2020
Review #1 received
Received 22 Mar, 2020
Reviewer #1 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
First submitted
On 20 Feb, 2020
Editor assigned
On 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically-ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy.
Methods: Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager.
Results: Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (OR 1.56, 95% C.I 1.28-1.90, P = 0 .0001), lower mortality rates (OR 0.68, 95% C.I 0.55-0.84, P = 0 .0003), higher microbiological success rates (OR 1.52, 95% C.I 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (OR -1.27, 95% C.I -2.45—0.08, P = 0.04) in critically ill patients.
Conclusion: There is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. Therefore, this alternative infusion strategy could be recommended in clinical practice.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
This is a list of supplementary files associated with this preprint. Click to download.
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