Antimicrobial Monotherapy versus Combination Therapy for the Treatment of Complicated Intra‐Abdominal Infections. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Petite, Sarah E.; Bauer, Seth R.; Bollinger, Jessica E.; Ahrens, Christine L.; Harinstein, Lisa M.
• Is Part Of: Pharmacotherapy. Volume 36:Issue 11(2016)
• Page Start: 1138
• Page End: 1144
• Publication Date: 2016-11
• Subjects: infectious disease -- critical care -- vancomycin; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; Drug Therapy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1002/phar.1847
• Languages: English
• ISSNs: 0277-0008

Abstract

Abstract : Study Objective: It is unknown if β‐lactam monotherapy is sufficient for complicated intra‐abdominal infections or if broader coverage is required, such as with vancomycin. This study sought to determine the clinical outcomes of piperacillin/tazobactam (PIP/TAZ) monotherapy compared to combination therapy with vancomycin and PIP/TAZ for complicated intra‐abdominal infections among patients within a surgical intensive care unit (ICU). Design: Retrospective cohort study. Setting: Three surgical ICUs at a tertiary academic medical center. Patients: Four hundred seventeen patients with a secondary peritonitis identified by International Classification of Diseases, Ninth Revision codes who received either PIP/TAZ monotherapy (228 patients) or PIP/TAZ and vancomycin combination therapy (189 patients). Measurements and Main Results: The primary outcome was day 28 clinical cure; secondary outcomes included day 7 clinical cure, length of stay (LOS), and mortality. There were no statistically significant differences between the monotherapy and combination therapy groups with respect to day 28 clinical cure (33.9% vs 25.5%, p=0.064), day 7 clinical cure (23.6% vs 17.6%, p=0.14), or 28‐day mortality (7% vs 7.9%, p=0.72). LOS in the ICU was significantly shorter in the monotherapy group (6 days) compared with the combination therapy group (7 days; p=0.04); however, hospital LOS was not significantly different. Conclusions: No difference was observed in clinical cure rates at day 28 or day 7 between those who received PIP/TAZ monotherapy compared to PIP/TAZ and vancomycin combination therapy.