Selection of piperacillin/tazobactam infusion mode guided by SOFA score in cancer patients with hospital-acquired pneumonia: a randomized controlled study

Figures & data

Table 1 The comparison of clinical data before treatment

	L and Con groups (n =120)			M group (n=53)			S group (n=67)
	L group	Con group	p-value	M1 group	M2 group	p-value	S1 group	S2 group	p-value
	(n=60)	(n=60)		(n=29)	(n=24)		(n=32)	(n=35)
SOFA score	10.77±5.896	11.85±5.719	0.309	5.45±1.502	5.58±1.442	0.741	15.56±3.732	16.20±2.837	0.432
APACHE II score	20.35±5.272	22.68±7.736	0.056	16.83±3.496	16.04±3.099	0.395	25.25±4.197	27.17±6.883	0.177
CPIS score	8.85±1.793	8.53±1.546	0.302	8.55±1.429	8.21±1.318	0.368	9.19±2.055	8.69±1.641	0.277
MIC (mg/L)	11.07±3.922	11.47±3.998	0.581	11.03±3.950	11.00±3.956	0.975	11.25±3.992	11.66±4.043	0.680
OI (mmHg)	204.42±34.36	198.28±34.03	0.328	227.7±25.19	225.5±24.15	0.746	182.3±26.31	180.2±27.26	0.751
PCT (ng/mL)	6.26±6.950	5.98±6.058	0.815	5.66±5.367	5.56±7.856	0.957	6.21±5.893	6.60±6.665	0.799
Albumin (g/L)	26.25±2.972	26.10±2.874	0.779	26.34±2.349	27.42±2.083	0.088	26.16±3.122	25.54±3.257	0.435
Ccr (mL/min)	61.40±6.730	63.43±7.335	0.116	66.38±6.758	65.29±6.511	0.556	61.25±7.535	60.34±6.183	0.591

Notes: The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cut-off value of 9, the patients were regrouped into M (mild) and S (severe) groups. M1: mild group with prolonged administration; M2: mild group with traditional administration; S1: severe group with prolonged administration; S2: severe group with traditional administration.

Abbreviations: APACHE II, acute physiology and chronic health evaluation II; Ccr, creatinine clearance; CPIS, clinical pulmonary infection score; MIC, minimum inhibitory concentration; OI, oxygenation index; PCT, procalcitonin; SOFA, Sequential Organ Failure Assessment.

Table 2 The comparison of general data before treatment

	L and Con groups (n=120)			M group (n=53)			S group (n=67)
	L group	Con group	p-value	M1 group	M2 group	p-value	S1 group	S2 group	p-value
	(n=60)	(n=60)		(n=29)	(n=24)		(n=32)	(n=35)
Age (years)	67.40±7.727	69.50±6.604	0.112	67.34±7.898	69.9±6.171	0.200	67.5±7.573	69.2±7.051	0.337
Gender (male/female)	37/23	29/31	0.144	17/12	11/13	0.358	20/12	18/17	0.365
BMI (kg/m^2)	22.37±1.946	23.29±4.033	0.109	22.23±1.868	23.25±3.802	0.210	22.45±2.012	23.36±4.285	0.273
Primary disease (cases)			0.332			0.710			0.877
Lung cancer	14	16		9	4		8	8
UGC	26	30		11	13		15	16
LGC	18	12		6	7		7	11
Other cancers	2	2		3	0		2	0
Incision site (cases)			0.698			0.175			0.869
Chest incision	14	16		9	4		8	8
Abdominal incision	33	26		14	12		16	18
TI	13	18		6	8		8	9
Initial pathogen (cases)			0.860			0.407			0.833
PA	14	15		10	9		6	6
EC	7	11		4	4		3	8
KP	15	7		4	4		8	6
AB	12	9		1	4		9	5
SM	2	6		2	3		1	4
EC	9	10		6	0		4	6
Other	1a	2b		2	0		1	0

Notes:

a Proteus mirabilis;

b Acinetobacter junii. The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cut-off value of 9, the patients were regrouped into M (mild) and S (severe) groups. M1: mild group with prolonged administration; M2: mild group with traditional administration; S1: severe group with prolonged administration; S2: severe group with traditional administration.

Abbreviations: AB, Acinetobacter baumannii; BMI, body mass index; EC, Enterobacter cloacae; EC, Escherichia coli; KP, Klebsiella pneumoniae; LGC, lower gastrointestinal cancer; PA, Pseudomonas aeruginosa; SM, Serratia marcescens; TI, thoracoabdominal incision; UGC, upper gastrointestinal cancer.

Figure 1 %fT>MIC in L group and Con group with MIC of 8 and 16 µg/mL.

Notes: The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. %fT >MIC represents the percent time that free drug concentrations remain above the MIC.
Abbreviation: MIC, minimum inhibitory concentration.

Figure 2 ROC curve of SOFA score, APACHE II and CPIS score. When the SOFA score was 9, the sensitivity was 84% and the specificity was 57%.

Abbreviations: APACHE II, acute physiology and chronic health evaluation II; CPIS, clinical pulmonary infection score; ROC, receiver operating characteristic; SOFA, Sequential Organ Failure Assessment.

Figure 3 Survival curve of L group and Con group.

Note: The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion.

Table 3 The comparison of clinical data in each group after treatment

	L and Con groups (n =120)			M group (n=53)			S group (n=67)
	L group	Con group	p-value	M1 group	M2 group	p-value	S1 group	S2 group	p-value
	(n=60)	(n=60)		(n=29)	(n=24)		(n=32)	(n=35)
Antibiotic usage (days)	11.121±0.772	13.227±0.605	0.124	11.48±3.55	10.42±2.569	0.225	12.94±3.340	14.66±3.386	0.041
Ventilator time (h)	145.95±21.46	152.01±35.78	0.515	5.79±4.15	6.13±4.28	0.956	126.09±12.91	169.36±16.45	0.043
Survival time (days)	27.77±0.127	24.15±1.029	0.027	28.00±0.00	27.17±4.082	0.276	27.56±1.243	21.69±9.048	0.001
Clinical efficacy (%)	88.33	86.67	0.044	96.55	96.55	0.448	78.13	57.14	0.007
BE (%)	98.33	75.00	0.000	100.00	83.33	0.011	96.88	71.43	0.005
28-day mortality (%)	1.67	8.33	0.023	0.00	0.00	1.000	3.12	14.29	0.027

Notes: The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cut-off value of 9, the patients were regrouped into M (mild) and S (severe) groups. M1: mild group with prolonged administration; M2: mild group with traditional administration; S1: severe group with prolonged administration; S2: severe group with traditional administration.

Abbreviation: BE, bacteriologic efficacy.

Figure 4 Survival curve of M1 and M2 groups.

Notes: There was no significant difference in the survival time between M1 and M2 groups. The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cut-off value of 9, the patients were regrouped into M (mild) and S (severe) groups. M1: mild group with prolonged administration; M2: mild group with traditional administration.

Figure 5 Survival curve of S1 and S2 groups.

Notes: The survival of S1 group was better than that of S2 group. The Con group (conventional treatment group) received traditional infusion of TZP and the L group (improved administration group) received it as prolonged infusion. Blood drug concentration was detected at different time points. Based on the SOFA cutoff value of 9, the patients were regrouped into M (mild) and S (severe) groups. S1: severe group with prolonged administration; S2: severe group with traditional administration.