Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation
The optimal regimens of piperacillin/sulbactam (PIS 2:1), piperacillin/tazobactam (PTZ 8:1), and cefoperazone/sulbactam (CSL 2:1) are not well defined in patients based on renal function. This study was conducted to identify optimal regimens of BLBLIs in these patients. The antimicrobial sensitivity...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/2/363 |
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| author | Xueting Wang Luying Xiong Wei Yu Chen Huang Jinru Ji Chaoqun Ying Zhiying Liu Yunbo Chen Yonghong Xiao |
| author_facet | Xueting Wang Luying Xiong Wei Yu Chen Huang Jinru Ji Chaoqun Ying Zhiying Liu Yunbo Chen Yonghong Xiao |
| author_sort | Xueting Wang |
| collection | DOAJ |
| description | The optimal regimens of piperacillin/sulbactam (PIS 2:1), piperacillin/tazobactam (PTZ 8:1), and cefoperazone/sulbactam (CSL 2:1) are not well defined in patients based on renal function. This study was conducted to identify optimal regimens of BLBLIs in these patients. The antimicrobial sensitivity test was performed by a two-fold agar dilution method. Monte Carlo simulation (MCS) was used to simulate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) for various dosing regimens in patients with different renal functions. For strains with an MIC ≤ 8/4 mg/L, PIS 4.5 g q6h achieved 99.03%PTA in the subset of patients with creatinine clearance (CrCL) > 90 mL/min. For patients with CrCL 60–90 mL/min, PIS 4.5 g q6h achieved 81.2% CFR; for those with CrCL 40–59 mL/min, PIS 4.5 g q8h achieved 80.25% CFR. However, for patients infected by ESBL-producing <i>Enterobacteriaceae</i>, PIS 4.5 g q6h achieved a CFR lower than 80%. For patients infected by <i>A. baumannii</i> with a CrCL of 31–60 mL/min, PIS 6.0 g q8h and 4.5 g q6h achieved 81.24% and 82.42% CFR, respectively. For those infected by <i>P. aeruginosa</i>, PIS 4.5 g q6h reached 90% CFR. PIS and PTZ achieved a similar CFR when piperacillin was at the same dose. The CFRs of CSL were much lower than those of the other two agents in <i>Enterobacteriaceae</i> and <i>P. aeruginosa</i> infections. The antibacterial spectrum of PIS is superior to that of PTZ and CSL. Higher dosages and dosing adjustment according to renal function should be considered to treat Gram-negative bacterial BSIs. |
| first_indexed | 2024-03-11T09:15:20Z |
| format | Article |
| id | doaj.art-c7096b4334a641c9931a928a170df0e7 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-11T09:15:20Z |
| publishDate | 2023-02-01 |
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| series | Antibiotics |
| spelling | doaj.art-c7096b4334a641c9931a928a170df0e72023-11-16T18:43:57ZengMDPI AGAntibiotics2079-63822023-02-0112236310.3390/antibiotics12020363Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo SimulationXueting Wang0Luying Xiong1Wei Yu2Chen Huang3Jinru Ji4Chaoqun Ying5Zhiying Liu6Yunbo Chen7Yonghong Xiao8State Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaDepartment of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo 315000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaState Key Laboratory of Infectious Disease Diagnosis and Treatment, National Clinical Medical Research Center for Infectious Diseases, Collaborative Innovation Center for Infectious Disease Diagnosis and Treatment, The First Hospital of Zhejiang University School of Medicine, Hangzhou 310000, ChinaThe optimal regimens of piperacillin/sulbactam (PIS 2:1), piperacillin/tazobactam (PTZ 8:1), and cefoperazone/sulbactam (CSL 2:1) are not well defined in patients based on renal function. This study was conducted to identify optimal regimens of BLBLIs in these patients. The antimicrobial sensitivity test was performed by a two-fold agar dilution method. Monte Carlo simulation (MCS) was used to simulate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) for various dosing regimens in patients with different renal functions. For strains with an MIC ≤ 8/4 mg/L, PIS 4.5 g q6h achieved 99.03%PTA in the subset of patients with creatinine clearance (CrCL) > 90 mL/min. For patients with CrCL 60–90 mL/min, PIS 4.5 g q6h achieved 81.2% CFR; for those with CrCL 40–59 mL/min, PIS 4.5 g q8h achieved 80.25% CFR. However, for patients infected by ESBL-producing <i>Enterobacteriaceae</i>, PIS 4.5 g q6h achieved a CFR lower than 80%. For patients infected by <i>A. baumannii</i> with a CrCL of 31–60 mL/min, PIS 6.0 g q8h and 4.5 g q6h achieved 81.24% and 82.42% CFR, respectively. For those infected by <i>P. aeruginosa</i>, PIS 4.5 g q6h reached 90% CFR. PIS and PTZ achieved a similar CFR when piperacillin was at the same dose. The CFRs of CSL were much lower than those of the other two agents in <i>Enterobacteriaceae</i> and <i>P. aeruginosa</i> infections. The antibacterial spectrum of PIS is superior to that of PTZ and CSL. Higher dosages and dosing adjustment according to renal function should be considered to treat Gram-negative bacterial BSIs.https://www.mdpi.com/2079-6382/12/2/363Monte Carlo simulationbloodstream infectionspharmacokinetics/pharmacodynamicspiperacillin/sulbactampiperacillin/tazobactamcefoperazone/sulbactam |
| spellingShingle | Xueting Wang Luying Xiong Wei Yu Chen Huang Jinru Ji Chaoqun Ying Zhiying Liu Yunbo Chen Yonghong Xiao Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation Antibiotics Monte Carlo simulation bloodstream infections pharmacokinetics/pharmacodynamics piperacillin/sulbactam piperacillin/tazobactam cefoperazone/sulbactam |
| title | Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation |
| title_full | Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation |
| title_fullStr | Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation |
| title_full_unstemmed | Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation |
| title_short | Evaluation of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam Dosages in Gram-Negative Bacterial Bloodstream Infections by Monte Carlo Simulation |
| title_sort | evaluation of piperacillin sulbactam piperacillin tazobactam and cefoperazone sulbactam dosages in gram negative bacterial bloodstream infections by monte carlo simulation |
| topic | Monte Carlo simulation bloodstream infections pharmacokinetics/pharmacodynamics piperacillin/sulbactam piperacillin/tazobactam cefoperazone/sulbactam |
| url | https://www.mdpi.com/2079-6382/12/2/363 |
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