Extended versus Intermittent Infusions of Piperacillin-Tazobactam in Patients with Febrile Neutropenia

BACKGROUND : Febrile neutropenia is an oncologic emergency that requires quick intervention with antipseudomonal beta-lactam antibiotics, such as piperacillin-tazobactam. Previous studies suggest that extended infusions of beta-lactam antibiotics may improve clinical outcomes; to date, only 3 previous studies have investigated the use of extended infusions of beta-lactam antibiotics in this patient population.

OBJECTIVE : To determine the effectiveness in reaching defervescence using extended infusions of piperacillin-tazobactam in oncologic patients with febrile neutropenia.

METHODS : This retrospective chart review compared the benefits of using extended infusions versus intermittent infusions of piperacillin-tazobactam in patients with febrile neutropenia. Adults with cancer who were admitted to a community teaching hospital between January 2012 and March 2017 with febrile neutropenia were included if they received infusions with piperacillin-tazobactam. Patients were divided into 2 groups based on the type of piperacillin-tazobactam infusion they received: intermittent infusions were infused over 30 minutes, whereas the extended infusions were given over 4 hours.

RESULTS : The study included 50 patients who were divided into 2 groups: 16 patients received extended infusions of piperacillin-tazobactam and 34 received intermittent infusions of the drug. The patients’ baseline characteristics between the 2 groups were homogeneous. No difference was found between the groups regarding patients achieving defervescence at 24 hours, defined as the first temperature of ≤100.4°F that was sustained for at least 24 hours (ie, 50% in the extended infusions group vs 53% in the intermittent infusions group;  P  = .85) or in the median time to defervescence (20.8 hours vs 22.8 hours, respectively;  P  = .84). Multivariate analyses indicated that receiving prophylactic antibiotics increased the odds of reaching defervescence at 24 hours by 7.66 (95% confidence interval, 1.07-54.72;  P  = .04).

CONCLUSION : These findings demonstrate that extended infusions of piperacillin-tazobactam resulted in similar outcomes to intermittent infusions, including defervescence, duration of antibiotic use, inpatient mortality, mortality within 30 days, and antibiotic failure. Further prospective research is needed to confirm these findings.