Piperacillin/Tazobactam Dose Optimization in the Setting of Piperacillin/Tazobactam-susceptible, Carbapenem-resistant Pseudomonas aeruginosa : Time to Reconsider Susceptible Dose Dependent
Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved..
PURPOSE: This study evaluates the in vitro potency of piperacillin/tazobactam among a global collection of carbapenem-resistant Pseudomonas aeruginosa (CR-PA) and assesses the adequacy of the Clinical and Laboratory Standards Institute (CLSI) P aeruginosa breakpoint dose in the setting of CR-PA using Monte Carlo simulation.
METHODS: Isolates were collected during the Enhancing Rational Antimicrobials Against Carbapenem-Resistant P aeruginosa (ERACE-PA) Global Surveillance Program. Piperacillin/tazobactam MICs were determined using broth microdilution per CLSI standards. A 5000-patient Monte Carlo simulation was performed using various piperacillin/tazobactam dosing regimens to determine the probability of target attainment (PTA) for 50% free time above the MIC. The MIC distribution of piperacillin/tazobactam-susceptible CR-PA was used to calculate cumulative fraction of response (CFR). Optimal PTA and CFR were defined as 90% target achievement.
FINDINGS: A total of 28% of tested CR-PA were piperacillin/tazobactam susceptible. Of these, 71% had MICs of 8 to 16/4 mg/L. Doses of 3.375 g q6h as 0.5-hour infusion (current breakpoint dose) had adequate PTA at MIC of 8/4 mg/L (CFR, 81%); however, extended infusion of 3 or 4 hours improved PTA at 16/4 mg/L (CFR, >90%). Doses of 4.5 g q8h as a 4-hour infusion and 4.5 g q6h as a 3-hour infusion both provide >90% PTA at an MIC of 16 mg/L (CFRs, 97 and 100%, respectively), favoring susceptible dose dependent interpretive criteria with these regimens.
IMPLICATIONS: Although susceptible, piperacillin/ tazobactam has reduced potency in CR-PA. If piperacillin/tazobactam is used for susceptible CR-PA, high-doses (4.5 g q6h) and extended infusion (3 hours or continuous infusion) are needed to optimize exposure.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2023 |
---|---|
Erschienen: |
2023 |
Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
---|---|
Enthalten in: |
Clinical therapeutics - 45(2023), 1 vom: 31. Jan., Seite 72-77 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Gill, Christian M [VerfasserIn] |
---|
Links: |
---|
Anmerkungen: |
Date Completed 28.02.2023 Date Revised 21.03.2023 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1016/j.clinthera.2022.12.004 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM351044574 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM351044574 | ||
003 | DE-627 | ||
005 | 20231226050402.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2023 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1016/j.clinthera.2022.12.004 |2 doi | |
028 | 5 | 2 | |a pubmed24n1170.xml |
035 | |a (DE-627)NLM351044574 | ||
035 | |a (NLM)36593150 | ||
035 | |a (PII)S0149-2918(22)00410-6 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Gill, Christian M |e verfasserin |4 aut | |
245 | 1 | 0 | |a Piperacillin/Tazobactam Dose Optimization in the Setting of Piperacillin/Tazobactam-susceptible, Carbapenem-resistant Pseudomonas aeruginosa |b Time to Reconsider Susceptible Dose Dependent |
264 | 1 | |c 2023 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 28.02.2023 | ||
500 | |a Date Revised 21.03.2023 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved. | ||
520 | |a PURPOSE: This study evaluates the in vitro potency of piperacillin/tazobactam among a global collection of carbapenem-resistant Pseudomonas aeruginosa (CR-PA) and assesses the adequacy of the Clinical and Laboratory Standards Institute (CLSI) P aeruginosa breakpoint dose in the setting of CR-PA using Monte Carlo simulation | ||
520 | |a METHODS: Isolates were collected during the Enhancing Rational Antimicrobials Against Carbapenem-Resistant P aeruginosa (ERACE-PA) Global Surveillance Program. Piperacillin/tazobactam MICs were determined using broth microdilution per CLSI standards. A 5000-patient Monte Carlo simulation was performed using various piperacillin/tazobactam dosing regimens to determine the probability of target attainment (PTA) for 50% free time above the MIC. The MIC distribution of piperacillin/tazobactam-susceptible CR-PA was used to calculate cumulative fraction of response (CFR). Optimal PTA and CFR were defined as 90% target achievement | ||
520 | |a FINDINGS: A total of 28% of tested CR-PA were piperacillin/tazobactam susceptible. Of these, 71% had MICs of 8 to 16/4 mg/L. Doses of 3.375 g q6h as 0.5-hour infusion (current breakpoint dose) had adequate PTA at MIC of 8/4 mg/L (CFR, 81%); however, extended infusion of 3 or 4 hours improved PTA at 16/4 mg/L (CFR, >90%). Doses of 4.5 g q8h as a 4-hour infusion and 4.5 g q6h as a 3-hour infusion both provide >90% PTA at an MIC of 16 mg/L (CFRs, 97 and 100%, respectively), favoring susceptible dose dependent interpretive criteria with these regimens | ||
520 | |a IMPLICATIONS: Although susceptible, piperacillin/ tazobactam has reduced potency in CR-PA. If piperacillin/tazobactam is used for susceptible CR-PA, high-doses (4.5 g q6h) and extended infusion (3 hours or continuous infusion) are needed to optimize exposure | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 4 | |a carbapenem-resistant Pseudomonas aeruginosa | |
650 | 4 | |a pharmacodynamics | |
650 | 4 | |a pharmacokinetics | |
650 | 4 | |a piperacillin/tazobactam | |
650 | 4 | |a susceptible dose dependent | |
650 | 7 | |a Piperacillin |2 NLM | |
650 | 7 | |a X00B0D5O0E |2 NLM | |
650 | 7 | |a Tazobactam |2 NLM | |
650 | 7 | |a SE10G96M8W |2 NLM | |
650 | 7 | |a Penicillanic Acid |2 NLM | |
650 | 7 | |a 87-53-6 |2 NLM | |
650 | 7 | |a Piperacillin, Tazobactam Drug Combination |2 NLM | |
650 | 7 | |a 157044-21-8 |2 NLM | |
650 | 7 | |a Mitomycin |2 NLM | |
650 | 7 | |a 50SG953SK6 |2 NLM | |
650 | 7 | |a Carbapenems |2 NLM | |
650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
700 | 1 | |a Nicolau, David P |e verfasserin |4 aut | |
700 | 0 | |a ERACE-PA Global Study Group |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Clinical therapeutics |d 1984 |g 45(2023), 1 vom: 31. Jan., Seite 72-77 |w (DE-627)NLM012642290 |x 1879-114X |7 nnns |
773 | 1 | 8 | |g volume:45 |g year:2023 |g number:1 |g day:31 |g month:01 |g pages:72-77 |
856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.clinthera.2022.12.004 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 45 |j 2023 |e 1 |b 31 |c 01 |h 72-77 |