Sofie A M Dhaese1, Magalie De Kezel2, Maxime Callant3, Jerina Boelens4, Liesbet De Bus5, Pieter Depuydt6, Jan J De Waele7. 1. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: sofie.dhaese@ugent.be. 2. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Electronic address: magalie.dekezel@ugent.be. 3. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Electronic address: maxime.callant@ugent.be. 4. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium. Electronic address: jerina.boelens@ugent.be. 5. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: liesbet.debus@ugent.be. 6. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: pieter.depuydt@ugent.be. 7. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: jan.dewaele@ugent.be.
Abstract
BACKGROUND: Prolonged infusion of beta-lactam antibiotics is broadly recognized as a strategy to optimize antibiotic therapy by achieving a higher percentage of time that concentrations remain above the minimal inhibitory concentration (% fT>MIC), i.e. the pharmacokinetic/pharmacodynamic (PK/PD) index. However, %fT>MIC may not be the PK/PD index of choice for inhibition of resistance emergence and it is therefore unsure what impact prolonged infusion of beta-lactam antibiotics may have on the emergence of resistance. METHODS: A retrospective cohort study including 205 patients receiving either intermittent (101 patients) or continuous (104 patients) infusion of piperacillin/tazobactam or meropenem was conducted in the ICU of the Ghent University Hospital. Logistic regression analysis was used to develop a prediction model and to determine whether the mode of infusion was a predictor of emergence of antimicrobial resistance. RESULTS: Resistant strains emerged in 24 out of the 205 patients (11.7%). The mode of infusion was no predictor of emergence of antimicrobial resistance. Infection with Pseudomonas aeruginosa was associated with a significantly higher risk for emergence of resistance. CONCLUSIONS: In this retrospective cohort study, the emergence of antimicrobial resistance to piperacillin/tazobactam or meropenem was not related to the mode of infusion.
BACKGROUND: Prolonged infusion of beta-lactam antibiotics is broadly recognized as a strategy to optimize antibiotic therapy by achieving a higher percentage of time that concentrations remain above the minimal inhibitory concentration (% fT>MIC), i.e. the pharmacokinetic/pharmacodynamic (PK/PD) index. However, %fT>MIC may not be the PK/PD index of choice for inhibition of resistance emergence and it is therefore unsure what impact prolonged infusion of beta-lactam antibiotics may have on the emergence of resistance. METHODS: A retrospective cohort study including 205 patients receiving either intermittent (101 patients) or continuous (104 patients) infusion of piperacillin/tazobactam or meropenem was conducted in the ICU of the Ghent University Hospital. Logistic regression analysis was used to develop a prediction model and to determine whether the mode of infusion was a predictor of emergence of antimicrobial resistance. RESULTS: Resistant strains emerged in 24 out of the 205 patients (11.7%). The mode of infusion was no predictor of emergence of antimicrobial resistance. Infection with Pseudomonas aeruginosa was associated with a significantly higher risk for emergence of resistance. CONCLUSIONS: In this retrospective cohort study, the emergence of antimicrobial resistance to piperacillin/tazobactam or meropenem was not related to the mode of infusion.
Authors: M García-Queiruga; B Feal Cortizas; F Lamelo Alfonsín; S Pertega Diaz; I Martín-Herranz Journal: Rev Esp Quimioter Date: 2021-03-16 Impact factor: 1.553