Traditional vs. Extended Cefepime Infusion in Critically Ill Patients
NEW ORLEANS, LA—Patients with Pseudomonas aeruginosa bacteremia or pneumonia had a reduced 28-day all-cause mortality and length of stay in the intensive care unit (ICU) when administered an extended infusion of cefepime, a study presented at IDWeek 2016 has shown.
Monte Carlo simulations have shown that extended infusion of cefepime results in a higher cumulative fraction of response against P. aeruginosa. Cory Vela, PharmD, from the H. Lee Moffitt Cancer Center and Research institute, Tampa, FL, and coauthors conducted a study to compare clinical outcomes between traditional infusion (30 minutes) vs. extended infusion (4 hours) in ICU patients for the management of P. aeruginosa bacteremia or pneumonia.
The primary objective of the retrospective, multicenter cohort review (n=146) was to determine the 28-day mortality rate of extended vs. traditional infusion of cefepime in ICU patients with documented P. aeruginosa bacteremia or pneumonia. Secondary objectives included ICU length of stay, days on mechanical ventilation, and overall treatment days between the extended and traditional infusion regimens.
The review showed that extended infusion cefepime was associated with a statistically significant decrease in 28-day all-cause mortality vs. traditional infusion cefepime (10% vs. 30%; P=0.0172). Length of stay in the ICU was significantly shorter in the extended infusion group vs. traditional infusion group (16 days vs. 24 days; P=0.016).
"Other variables such as number of treatment days, days on mechanical ventilation, cefepime (gram per person per treatment course) were not statistically significant," reported Dr. Vela.
The SOFA score (odds ratio [OR] 1.333, 95% CI: 1.087–1.637) was independently associated with 28-day mortality whereas minimum inhibitory concentration (MIC) ≤2 (OR 0.26, 95% CI: 0.667–0.984) and extended infusion cefepime (OR 0.247, 95% CI: 0.723–0.841) were associated with reduced mortality, according to the multivariate analysis.
Study authors added that larger prospective studies are needed to confirm the study's findings.