Impact of Extended- Versus Intermittent-Infusion Cefepime on Clinical Outcomes in Hospitalized Patients.
Reese A CosimiZachary W HoweLindsay M SaumPublished in: Hospital pharmacy (2020)
Background: Pharmacodynamic models support potential improved antimicrobial pharmacokinetic and pharmacodynamic goal attainment in patients treated with extended-infusion (EI) versus intermittent-infusion (II) cefepime. Small clinical studies demonstrate inconsistent findings in patient outcomes, necessitating a deeper review of this administration method. Methods: This was a retrospective cohort study comparing patients receiving EI versus II cefepime between September 1, 2017, and March 31, 2018. The primary outcome was in-hospital all-cause mortality. Secondary objectives included length of hospital and ICU stay, time to defervescence, duration of therapy, duration of mechanical ventilation, and readmission rate. Subgroup analyses for the primary objective were conducted based on comorbid burden and isolate susceptibilities. Results: No statistically significant differences were noted in the 645 included patients for the primary outcome between the EI and II groups (7.8% vs 10.4%, P = .32). Median length of stay was 9 days (IQR 12) versus 11 days (IQR 14) (P = .30), respectively. In addition, statistical significance was not seen in any of the subgroups for the primary outcome including patients with APACHE II score ≥ 20 (17.4% vs 30.6%, P = .26) and for infections caused by Pseudomonas aeruginosa (5.9% vs 20.0%, P = .23) or Enterobacteriaceae (11.1% vs 20.0%, P = .13) with minimum inhibitory concentration (MIC) ≥ 4. Conclusion: No statistically significant differences were noted between EI and II groups, although benefits in specific subpopulations may exist when these results are correlated with findings from studies examining alternative antipseudomonal beta lactams.
Keyphrases
- patient reported outcomes
- mechanical ventilation
- pseudomonas aeruginosa
- intensive care unit
- low dose
- healthcare
- acute respiratory distress syndrome
- clinical trial
- high intensity
- newly diagnosed
- randomized controlled trial
- drug resistant
- emergency department
- acute care
- end stage renal disease
- chronic kidney disease
- biofilm formation
- adverse drug
- klebsiella pneumoniae
- acinetobacter baumannii
- bone marrow
- cell therapy
- candida albicans