중환자실 내 병원성 폐렴 치료를 위한 Piperacillin/Tazobactam의 용량에 따른 효과와 안전성 비교
Comparison of Piperacillin/Tazobactam Dosing (13.5 g/day vs. 18 g/day) for the Treatment of Hospital-Acquired Pneumonia and Ventilator-associated Pneumonia in Intensive Care Unit
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Background: In July 2016, the Infectious diseases society of america and the american thoracic society (IDSA & ATS) published aguideline recommending piperacillin/tazobactam (Pip/Tazo) 18 g/day as the anti-pseudomonal dose for the treatment of pathogenicpneumonia. After the guideline was published, the Pip/Tazo dose used for the treatment of pathogenic pneumonia was changedfrom 13.5 g/day to 18 g/day in a superior general hospital intensive care unit (ICU). In this study, we analyzed the effectiveness andsafety of the new dose. Methods: Adult patients aged ≥19 years who were diagnosed with pneumonia in ICU and who received Pip/Tazo for 7 days or more from September 1, 2015 to May 31, 2017 were included in the study. The electronic medical record (EMR)was retrospectively analyzed. Results: At baseline, there was a significant difference between 44 patients treated with 13.5 g/dayand 31 patients treated with 18 g/day of Pip/Tazo. The 18 g/day-treatment group comprised more elderly patients than the 13.5 g/day-treatment group (p=0.028). The results of the treatment-effects analysis showed no significant difference between the twogroups. In case of safety data, there were significant differences in two parameters related to blood count, namely hemoglobin(p=0.016) and platelet count (p=0.011). Conclusion: Based on the significant difference in baseline age, there is a possibility thathigh-dose Pip/Tazo showed improved therapeutic effect. However, when high-dose Pip/Tazo was used, the blood cell count wasfound to drop from the reference value more frequently. Therefore, blood cell count should be monitored carefully when high-dosePip/Tazo is administered.
Abstract
Background: In July 2016, the Infectious diseases society of america and the american thoracic society (IDSA & ATS) published aguideline recommending piperacillin/tazobactam (Pip/Tazo) 18 g/day as the anti-pseudomonal dose for the treatment of pathogenicpneumonia. After the guideline was published, the Pip/Tazo dose used for the treatment of pathogenic pneumonia was changedfrom 13.5 g/day to 18 g/day in a superior general hospital intensive care unit (ICU). In this study, we analyzed the effectiveness andsafety of the new dose. Methods: Adult patients aged ≥19 years who were diagnosed with pneumonia in ICU and who received Pip/Tazo for 7 days or more from September 1, 2015 to May 31, 2017 were included in the study. The electronic medical record (EMR)was retrospectively analyzed. Results: At baseline, there was a significant difference between 44 patients treated with 13.5 g/dayand 31 patients treated with 18 g/day of Pip/Tazo. The 18 g/day-treatment group comprised more elderly patients than the 13.5 g/day-treatment group (p=0.028). The results of the treatment-effects analysis showed no significant difference between the twogroups. In case of safety data, there were significant differences in two parameters related to blood count, namely hemoglobin(p=0.016) and platelet count (p=0.011). Conclusion: Based on the significant difference in baseline age, there is a possibility thathigh-dose Pip/Tazo showed improved therapeutic effect. However, when high-dose Pip/Tazo was used, the blood cell count wasfound to drop from the reference value more frequently. Therefore, blood cell count should be monitored carefully when high-dosePip/Tazo is administered.
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