Outpatient therapy with piperacillin/tazobactam using elastomeric pumps in patients with Pseudomonas aeruginosa infection

AbstractThe aim of this study was to evaluate the efficacy and safety of outpatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps and to evaluate the economic impact compared with conventional hospital treatment in patients with Pseudomonas aeruginosa (PA) infections. This is an observational study. Patients with PA infection treated with continuous piperacillin-tazobactam infusion using elastomeric pumps in our hospital between January 2015 and December 2017 were included. Primary outcomes were mortality during antibiotic treatment and mortality at 30 days. Secondary outcomes were reinfection or relapse at 30 days and clinical cure rate. The cost of each episode was compared with theoretical cost of the same treatment using conventional hospitalization. 35 patients were included. One patient (2.9%) died during the treatment. Overall 30-day mortality was 5.7%. No death was related to infection by PA. One patient (2.9%) had a reinfection at 30 days. Cure was achieved in 93% of patients at the end of treatment. There were no severe complications related to elastomeric pumps. Treatment cost with outpatient antimicrobial therapy was 67% lower than theoretical cost with conventional hospital treatment. Oupatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps in patients with PA infections is safe and effective with lower costs.

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CURE OF PSEUDOMONAS AERUGINOSA INFECTION IN NEUTROPENIC PATIENTS BY CONTINUOUS INFUSION OF CEFTAZIDIME

The Lancet ◽

10.1016/s0140-6736(88)91741-2 ◽

1988 ◽

Vol 331 (8591) ◽

pp. 937 ◽

Cited By ~ 25

Author(s):

S. Daenen ◽

H. de Vries-Hospers

Keyword(s):

Pseudomonas Aeruginosa ◽

Continuous Infusion ◽

Neutropenic Patients ◽

Pseudomonas Aeruginosa Infection

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Outpatient Parenteral Antimicrobial Therapy With Ceftolozane/Tazobactam via Continuous Infusion for Multidrug-Resistant Pseudomonas aeruginosa Osteomyelitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa409 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Judith Álvarez Otero ◽

Jose Luis Lamas Ferreiro ◽

Ana Sanjurjo Rivo ◽

Javier de la Fuente Aguado

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Therapy ◽

Continuous Infusion ◽

Antimicrobial Therapy ◽

Multidrug Resistant ◽

Effective Alternative ◽

Outpatient Parenteral Antimicrobial Therapy ◽

At Home

Abstract We present a case of Pseudomonas aeruginosa osteomyelitis treated with surgery and antibiotic therapy with ceftolozane-tazobactam in continuous infusion at home using an elastomeric pump. We discuss the use of ceftolozane-tazobactam in continuous infusion administered at home as an effective alternative for the treatment of multidrug-resistant Pseudomonas aeruginosa osteomyelitis.

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Modern Approaches to the Methods of Creating of Phage Basis for Treatment-Prophylactic a Drug of Bacteriophages Pseudomonas aeruginosa

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2018-17-2-37-45 ◽

2018 ◽

Vol 17 (2) ◽

pp. 37-45

Author(s):

O. A. Polygach ◽

N. N. Voroshilov ◽

N. V. Tikunova ◽

V. V. Morozova ◽

A. Y. Tikunov ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibacterial Activity ◽

Drug Design ◽

Antimicrobial Therapy ◽

Wide Spectrum ◽

Morphological Properties ◽

Genetic Groups ◽

Pseudomonas Aeruginosa Infection ◽

Cis Countries ◽

Regions Of Russia

Therapeutic and prophylactic preparations of bacteriophages are considered as an effective modern means of antimicrobial therapy of Pseudomonas aeruginosa infection. Bacteriophages that are part of the drugs must be certified for confirmation of their lytic and genetic properties, which ensures the safety and effectiveness of the use of drugs. In our study, biological and morphological properties were studied for drug design, the spectrum of antibacterial activity of bacteriophages isolated in various regions of Russia was determined. The most important stage of the work was research on ensuring genetic safety of bacteriophage preparations. As a result, a composition of 6 strains of lytic bacteriophages of P. aeruginosa (PaUfa №№ 1, 2, 3, 4, 6, 7) composed of the morphology of the virions to the families Podoviridae and Myoviridae, the order of Caudovirales, phylogenetic genetic groups phiKMV- likevirus , N4-likevirus, PB1-likevirus. The composition has a wide spectrum of antibacterial activity (90.7%) with respect to 818 collisional, epidemiologically significant hospital and clinical strains of P. aeruginosa bacteria, and also quite versatile for various remote territories of Russia and CIS countries.

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Evaluation Outcomes Associated with Alternative Dosing Strategies for Piperacillin/Tazobactam: A Systematic Review and Meta-Analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j33s4b ◽

2016 ◽

Vol 19 (2) ◽

pp. 274 ◽

Cited By ~ 3

Author(s):

Hui Yang ◽

Xiangli Cui ◽

Zhuo Ma ◽

Lihong Liu

Keyword(s):

Systematic Review ◽

Continuous Infusion ◽

Clinical Cure ◽

Observational Studies ◽

Clinical Cure Rate ◽

Meta Analysis ◽

Intermittent Infusion ◽

Cure Rate ◽

Randomized Controlled ◽

Dosing Strategies

A better dosing strategy can improve clinical outcomes for patients. We systematically reviewed the literatures to determine whether any clinical benefits exist for piperacillin/tazobactam by extended or continuous infusion. Methods - A search of PubMed, Web of Science, ProQuest, ScienceDirect, Cochrane, Embase and related ICAAC and ACCP conferences were conducted up to September 5, 2015. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently evaluated the methodology and extracted data from primary studies. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated. Results - Three randomized controlled trials and twelve observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significant cost effectiveness (OR -0.89.02, CI (-114.69,-63.35), P<0.00001). No statistical difference was observed for clinical cure rate (OR 1.64, 95% CI (0.88, 3.30), P=0.12) between the two dosing regimens. The sensitivity analysis showed the results were stable. Conclusions - Our systematic review and meta-analysis found that the outcomes associated with alternative dosing strategies of piperacillin/tazobactam have changed compared with conclusions before for several literatures with large samples published. Further data on the outcomes should be generated for a better understanding of the extended or continuous infusion strategy. On the whole, our meta-analysis suggested that the extended or continuous infusion should be recommended for clinical use only considering its economic advantage, but there was no significantly higher clinical cure rate and lower mortality rate compared with the conventional intermittent infusion. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Identification of Optimal Combinations for Empirical Dual Antimicrobial Therapy of Pseudomonas aeruginosa Infection: Potential Role of a Combination Antibiogram

Infection Control and Hospital Epidemiology ◽

10.1086/503175 ◽

2006 ◽

Vol 27 (4) ◽

pp. 413-415 ◽

Cited By ~ 20

Author(s):

Mari Mizuta ◽

Darren R. Linkin ◽

Irving Nachamkin ◽

Neil O. Fishman ◽

Mark G. Weiner ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Therapy ◽

Antimicrobial Therapy ◽

Potential Role ◽

Drug Combinations ◽

Fine Tuning ◽

Pseudomonas Aeruginosa Infection

To better determine the optimal combinations for empirical dual antimicrobial therapy of Pseudomonas aeruginosa infection, we evaluated the utility of a novel combination antibiogram. Although the combination antibiogram allowed modest fine-tuning of choices for dual antibiotic therapy, selections based on the 2 antibiograms did not differ substantively. Drug combinations with the broadest coverage were consistently composed of an aminoglycoside and a β-lactam.

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Efficacy of High-dose Nebulized Colistin in Ventilator-associated Pneumonia Caused by Multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii

Anesthesiology ◽

10.1097/aln.0b013e31827515de ◽

2012 ◽

Vol 117 (6) ◽

pp. 1335-1347 ◽

Cited By ~ 107

Author(s):

Qin Lu ◽

Rubin Luo ◽

Liliane Bodin ◽

Jianxin Yang ◽

Noël Zahr ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Resistant Strain ◽

Clinical Cure ◽

Clinical Cure Rate ◽

Multidrug Resistant ◽

High Dose ◽

Ventilator Associated Pneumonia ◽

Cure Rate ◽

Strain Group ◽

Multidrug Resistant Strain

Background Colistin often remains the only active agent against multidrug-resistant Gram-negative pathogens. The aim of the study was to assess efficacy of nebulized colistin for treating ventilator-associated pneumonia (VAP) caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Methods One hundred and sixty-five patients with VAP caused by P. aeruginosa and A. baumannii were enrolled in a prospective, observational, and comparative study. The sensitive strain group included 122 patients with VAP caused by P. aeruginosa and A. baumannii susceptible to β-lactams, aminoglycosides, or quinolones and treated with intravenous antibiotics for 14 days. The multidrug-resistant strain group included 43 patients with VAP caused by multidrug-resistant P. aeruginosa and A. baumannii and treated with nebulized colistin (5 million international units every 8 h) either in monotherapy (n=28) or combined to a 3-day intravenous aminoglycosides for 7-19 days. The primary endpoint was clinical cure rate. Aerosol was delivered using vibrating plate nebulizer. Results After treatment, clinical cure rate was 66% in sensitive strain group and 67% in multidrug-resistant strain group (difference -1%, lower limit of 95% CI for difference -12.6%). Mortality was not different between groups (23 vs. 16%). Among 16 patients with persisting or recurrent P. aeruginosa infection, colistin minimum inhibitory concentration increased in two patients. Conclusion Nebulization of high-dose colistin was effective to treat VAP caused by multidrug-resistant P. aeruginosa or A. baumannii. Its therapeutic effect was noninferior to intravenous β-lactams associated with aminoglycosides or quinolones for treating VAP caused by susceptible P. aeruginosa and A. baumannii.

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