Evaluation of the safety of piperacillin-tazobactam extended infusion
Background: Patients with cystic fibrosis (CF) may be treated with piperacillin-tazobactam (PZT) for acute pulmonary exacerbations. Extending the infusion of PZT is one strategy to increase efficacy. Direct comparison, with respect to incidence of acute kidney injury (AKI), between these two strategies has not been evaluated in pediatric patients with CF. The primary objective of this study was to compare the incidence of AKI in pediatric CF patients receiving extended infusion (EI) PZT versus traditional infusion (TI).
Methods: This IRB-approved, retrospective analysis included patients ages 30 days to 18 years that received PZT for at least 48 hours between 01/01/2008 and 01/01/2020. PZT was infused over thirty minutes (TI group) or four hours (EI group).
Results: 204 patients were included (TI:109, EI: 95). Median age was 8 years (4-13) and 7 years (3-12) in the TI and EI groups (p=0.15). The groups did not differ significantly in their baseline characteristics. There were 12 (11%) AKIs in the TI group and 8 (8.4%) in the EI group (p=0.53). There was 1 occurrence of serum sickness in the TI group and none in the EI group. The incidence of thrombocytopenia was similar between the two groups. Median treatment duration was 8 days (5-11) and 9 days (5-13) for the TI and EI groups respectively (p=0.24).
Conclusions: There was no significant increase in AKI in pediatric patients with CF receiving PZT by EI compared to TI. EI may be utilized to optimize the pharmacokinetics of PZT in pediatric CF patients.
Riggsbee D, Engdahl S, Pettit RS. Evaluation of the safety of piperacillin-tazobactam extended infusion in pediatric cystic fibrosis patients. Pediatr Pulmonol. 2023 Jan 2. doi: 10.1002/ppul.26299. Epub ahead of print. PMID: 36593628.