Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

Abstract 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.

Download Full-text

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

10.21203/rs.2.24493/v2 ◽

2020 ◽

Author(s):

Sarah Fawaz ◽

Stephen Barton ◽

Shereen Nabhani-Gebara

Keyword(s):

Confidence Interval ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Intermittent Infusion ◽

Prolonged Infusion ◽

Level Of Evidence ◽

Dosing Regimens ◽

Meta Analyses ◽

Antibiotic Dosing

Abstract 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 (Odds Ratio 1.56, 95% Confidence Interval 1.28-1.90, P = 0 .0001), lower mortality rates (Odds Ratio 0.68, 95% Confidence Interval 0.55-0.84, P = 0 .0003), higher microbiological success rates (Odds Ratio 1.52, 95% Confidence Interval 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (Odds Ratio -1.27, 95% Confidence Interval -2.45—0.08, P = 0.04) in critically ill patients.Conclusion: Results from this study show that 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. However, more rigorous scientific studies in critically ill patients are warranted to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy.

Download Full-text

Comparing Clinical Outcomes of Piperacillin-Tazobactam Administration and Dosage Strategies in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis

10.21203/rs.2.24493/v3 ◽

2020 ◽

Author(s):

Sarah Fawaz ◽

Stephen Barton ◽

Shereen Nabhani-Gebara

Keyword(s):

Confidence Interval ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Intermittent Infusion ◽

Prolonged Infusion ◽

Level Of Evidence ◽

Dosing Regimens ◽

Meta Analyses ◽

Antibiotic Dosing

Abstract 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 (Odds Ratio 1.56, 95% Confidence Interval 1.28-1.90, P = 0 .0001), lower mortality rates (Odds Ratio 0.68, 95% Confidence Interval 0.55-0.84, P = 0 .0003), higher microbiological success rates (Odds Ratio 1.52, 95% Confidence Interval 1.10-2.11, P = 0.01) and decreasing the length of hospital stay (Mean Difference -1.27, 95% Confidence Interval -2.45—0.08, P = 0.04) in critically ill patients.Conclusion: Results from this study show that 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. However, more rigorous scientific studies in critically ill patients are warranted to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy.

Download Full-text

Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽

10.1186/s13054-021-03540-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eleni Papoutsi ◽

Vassilis G. Giannakoulis ◽

Eleni Xourgia ◽

Christina Routsi ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Mortality And Morbidity ◽

Icu Admission ◽

All Cause Mortality ◽

Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

Download Full-text

Impact of cytomegalovirus reactivation on clinical outcomes in immunocompetent critically ill patients: protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-016-0303-8 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 6

Author(s):

Philippe Lachance ◽

Justin Chen ◽

Robin Featherstone ◽

Wendy Sligl

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Cytomegalovirus Reactivation

Download Full-text

Impact of Enteral Nutrition Formulations Containing Dietary Fiber on Diarrhea Outcomes in Hospitalized Critical Care Patients: A Systematic Review and Meta-Analysis

Current Developments in Nutrition ◽

10.1093/cdn/nzab047_005 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 842-842

Author(s):

Kelly Cara ◽

Andrew Beauchesne ◽

Taylor Wallace ◽

Mei Chung

Keyword(s):

Systematic Review ◽

Critical Care ◽

Enteral Nutrition ◽

Dietary Fiber ◽

Critically Ill ◽

Random Effects ◽

Critically Ill Patients ◽

Outcome Data ◽

Meta Analyses ◽

Critical Care Patients

Abstract Objectives The objective is to conduct a systematic review on the safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients. Methods This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Version 6.1,2020). Searches were implemented in four databases on 4/20/20. Results were limited to English language studies conducted in humans. Any clinical study design or case study measuring adverse events (e.g., diarrhea and mortality) or health outcomes (as defined in each study) associated with enteral nutrition interventions containing dietary fiber in adult critically ill patients was considered. Random effects meta-analyses were conducted on outcomes assessed by three or more included studies. Results Altogether, 18 articles were included, and 11 randomized controlled trials assessed diarrhea outcomes (i.e., diarrhea score and number or frequency of events). Six studies used the Hart and Dobb (1988) diarrhea score, and random effects meta-analyses showed the mean diarrhea scores were lower for fiber compared to non-fiber groups (n = 4, pooled mean difference: −2.78, 95% confidence interval: −4.10, −1.47). Five of seven reported group comparisons showed fewer diarrhea events for fiber compared with non-fiber groups, although the overall difference was not statistically significant (n = 7, pooled risk ratio: 0.68, 95% CI: 0.45, 1.02). For three studies using other or unspecified scoring methods, pooled results showed significantly fewer diarrhea events in the fiber groups compared to non-fiber groups (n = 3, pooled RR: 0.42, 95% CI: 0.20, 0.89). Studies reported no difference in incidence of mortality due to fiber interventions (n = 7, pooled RR: 0.99, 95% CI: 0.66, 1.48). Risk of bias for diarrhea outcomes was high due to missing outcome data, and there was some concern for bias due to randomization, measurement of the outcome, and selection of reported results. Conclusions Enteral nutrition formulas with fiber may help reduce incidence and severity of diarrhea in critically ill patients without increasing incidence of mortality. As these results are subject to bias, more high-quality studies are needed to verify this conclusion. Funding Sources This study was supported by funding from an unrestricted educational grant from Nestle Health Sciences.

Download Full-text