Selection of piperacillin/tazobactam infusion mode guided by SOFA score in cancer patients with hospital-acquired pneumonia: a randomized controlled study

• Main Authors: Lyu Y, Yang Y, Li X, Peng M, He X, Zhang P, Dong S, Wang W, Wang D
• Format: Article
• Language: English
• Published: Dove Medical Press 2017-12-01
• Series: Therapeutics and Clinical Risk Management
• Subjects: Cancer; Sequential Organ Failure Assessment score; Piperacillin; Tazobactam; Pneumonia; Antibiotics
• Online Access: https://www.dovepress.com/selection-of-piperacillintazobactam-infusion-mode-guided-by-sofa-score-peer-reviewed-article-TCRM

Yang Lyu,1,* Yang Yang,2,* Xin Li,3 Min Peng,3 Xin He,2 Peng Zhang,4 Shangwen Dong,4 Wanhua Wang,2 Donghao Wang1 1Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, 2Department of Anesthesia, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, 3Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin, 4Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China *These authors contributed equally to this work Background: This study aimed to select piperacillin/tazobactam (TZP) infusion mode guided by Sequential Organ Failure Assessment (SOFA) score in cancer patients with hospital-acquired pneumonia (HAP) postoperation.Patients and methods: A total of 120 cancer patients with postoperative HAP were divided into two groups: improved administration group (L group) and conventional treatment group (Con group). The Con group received traditional infusion of TZP and the L group received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cut-off value of 9, the patients were regrouped into M (mild) and S (severe) groups.Results: Percent time that the free drug concentrations remain above the minimum inhibitory concentration (%fT>MIC) was longer than 5 h in L group, but <4 h in Con group. Administration method (p=0.033, OX value 2.796, B value 1.028, 95% CI: 0.855–8.934) and SOFA score (p=0.038, OX value 0.080, B value -2.522, 95% CI: 0.007–0.874) were independent predictors of patient survival. In the S group, compared to conventional treatment, prolonged infusion mode resulted in shorter days of antibiotic use and shorter ventilator time, and achieved longer survival, better clinical efficacy, and lower 28-day mortality rate.Conclusion: For cancer patients with SOFA score ≥9, prolonged infusion of TZP could benefit the patients and obtain better clinical efficacy. Keywords: cancer, Sequential Organ Failure Assessment score, piperacillin, tazobactam, pneumonia, antibiotics