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John E. Mazuski - One of the best experts on this subject based on the ideXlab platform.
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Aminoglycosides for intra-Abdominal Infection: equal to the challenge?
Surgical Infections, 2020Co-Authors: Jeffrey A. Bailey, Katherine S. Virgo, Joseph T. Dipiro, Avery B. Nathens, Robert G. Sawyer, John E. MazuskiAbstract:Background: Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-Abdominal Infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these Infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-Abdominal Infection. Methods: Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-Abdominal Infection were identified by MEDLINE search. For each study, data were collected regarding the number of patients enrolled and evaluated, their basic demographic characteristics, the sources of the intra-Abdominal Infections, the number of failures as determined by the study investigators, quality score, and the use of serum drug concentrat...
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Clinical challenges and unmet needs in the management of complicated intra-Abdominal Infections.
Surgical Infections, 2020Co-Authors: John E. MazuskiAbstract:ABSTRACT Background: Management of complicated intra-Abdominal Infections involves invasive procedures for control of the source of the Infection and antimicrobial therapy directed against gram-negative and anaerobic pathogens. Application of these management principles to the individual patient is essential to optimize the patient's chances for recovery, while also avoiding unnecessary therapy that may have no clinical benefits, or that may carry risk. Methods: Based on a review of the literature, treatment guidelines, and expert opinion, the challenges of managing patients with complicated intra-Abdominal Infections are summarized using a patient stratification approach: “Lower risk” of treatment failure and death vs. “higher risk.” Results: Risk factors for treatment failure and death can be grouped into several categories, including the patient's pre-existing medical comorbidities and physiological response to the Infection, the extent of the intra-Abdominal Infection, and the presence of specific pat...
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the surgical Infection society revised guidelines on the management of intra Abdominal Infection
Surgical Infections, 2017Co-Authors: John E. Mazuski, Robert G. Sawyer, Jeffrey M Tessier, Evan P Nadler, Matthew R Rosengart, Phillip K Chang, Patrick J Oneill, Kevin P Mollen, Jared M Huston, Jose J DiazAbstract:Abstract Background: Previous evidence-based guidelines on the management of intra-Abdominal Infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the t...
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patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra Abdominal Infection
American Surgeon, 2016Co-Authors: Rishi Rattan, Robert G. Sawyer, John E. Mazuski, Casey J Allen, Therese M Duane, Reza Askari, Kaysie L Banton, Jeffrey A Claridge, Raul Coimbra, Joseph CuschieriAbstract:: A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-Abdominal Infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site Infection, recurrent intra-Abdominal Infection, extra-Abdominal Infection, and Clostridium difficile Infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site Infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-Abdominal Infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intra-Abdominal Infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.
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efficacy and safety of ceftazidime avibactam plus metronidazole versus meropenem in the treatment of complicated intra Abdominal Infection results from a randomized controlled double blind phase 3 program
Clinical Infectious Diseases, 2016Co-Authors: John E. Mazuski, Helen Broadhurst, Paul Newell, Leanne B Gasink, Jon Armstrong, Greg Stone, Douglas Rank, Lily Llorens, Jan PachlAbstract:Complicated intra-Abdominal Infection (cIAI) generally results from perforation or necrosis of the gastrointestinal tract and release of bacteria into the peritoneal and retroperitoneal space [1]. Many pathogens implicated in these Infections have developed resistance to standard antibiotics, thereby limiting treatment options. Moreover, the evolution of carbapenem-resistant Enterobacteriaceae is a growing concern [2, 3]. Thus, there is an urgent requirement for carbapenem-sparing therapies [4, 5]. Avibactam is a novel, first-in-class, non–β-lactam β-lactamase inhibitor that restores the in vitro activity of the established extended-spectrum antipseudomonal cephalosporin, ceftazidime, against Ambler class A, class C, and some class D β-lactamase–producing pathogens [6–9]. In phase 2 trials, ceftazidime-avibactam was effective and well tolerated in patients with cIAI (in combination with metronidazole) and complicated urinary tract Infections [10, 11]. Based on these data, ceftazidime-avibactam was approved by the US Food and Drug Administration (FDA) for the treatment of cIAI (in combination with metronidazole) and complicated urinary tract Infections (including pyelonephritis), in adults with limited or no alternative treatment options [12]. Here, we describe the results from 2 identical phase 3 trials combined to evaluate the efficacy and safety of ceftazidime-avibactam plus metronidazole versus meropenem in hospitalized adults with cIAI.
Patchen E Dellinger - One of the best experts on this subject based on the ideXlab platform.
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short course antimicrobial therapy does not increase treatment failure rate in patients with intra Abdominal Infection involving fungal organisms
Surgical Infections, 2018Co-Authors: Nathan R Elwood, Therese M Duane, Reza Askari, Joseph Cuschieri, Charles H Cook, Patrick J Oneill, Lena M Napolitano, Nicholas Namias, Christopher A Guidry, Patchen E DellingerAbstract:Abstract Background: Fungi frequently are isolated in intra-Abdominal Infections (IAI). The Study to Optimize Peritoneal Infection Therapy (STOP-IT) recently suggested short-course treatment for pa...
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diagnosis and management of complicated intra Abdominal Infection in adults and children guidelines by the surgical Infection society and the infectious diseases society of america
Clinical Infectious Diseases, 2010Co-Authors: Joseph S Solomkin, John E. Mazuski, Patrick J Oneill, John S Bradley, Keith A Rodvold, Ellie J C Goldstein, Ellen Jo Baron, Anthony W Chow, Patchen E Dellinger, Soumitra R EachempatiAbstract:Evidence-based guidelines for managing patients with intra-Abdominal Infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these Infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-Abdominal Infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
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surgical Infection society intra Abdominal Infection study prospective evaluation of management techniques and outcome
Archives of Surgery, 1993Co-Authors: Nicolas V Christou, Philip S. Barie, Patchen E Dellinger, Paul J Waymack, Harlan H StoneAbstract:• This prospective, open, consecutive, nonrandomized trial examined management techniques and outcome in severe peritonitis. A total of 239 patients with surgical Infection in the abdomen and an APACHE (acute physiology and chronic health evaluation) II score greater than 10 were studied. Seventy-seven patients (32%) died. Reoperation had a 42% mortality rate (35 of 83 patients died) compared with a 27% mortality rate (42 of 156 died ) in patients who did not undergo reoperation. Forty-six patients underwent one reoperation; 15, two reoperations; 10, three reoperations; five, four reoperations; and seven, five reoperations, with mortality rates of 43%, 40%, 30%, 40%, and 57%, respectively. There was no significant difference in mortality between patients treated with a "closed-abdomen technique" (31% mortality) and those treated with variations of the "open-abdomen" technique (44% mortality). Logistic regression analysis showed that a high APACHE II score, low serum albumin level, and high New York Heart Association cardiac function status were significantly and independently associated with death. Low serum albumin level, youth, and high APACHE II score were significantly and independently associated with reoperation. ( Arch Surg . 1993;128:193-199)
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guidelines for clinical care anti infective agents for intra Abdominal Infection a surgical Infection society policy statement
Archives of Surgery, 1992Co-Authors: John M A Bohnen, Joseph S Solomkin, Patchen E Dellinger, Stephen H Bjornson, Carey P PageAbstract:• Several antibiotics have been marketed for therapeutic use in intra-Abdominal Infection. Often, these agents do not provide a sufficient spectrum activity against both facultative and obligate anaerobic gram-negative organisms, or have certain toxic effects that would not otherwise support their use. Guidelines have been developed for selection of antibiotic therapy for intra-Abdominal Infections and are presented as a statement of the Surgical Infection Society endorsed by the Executive Council. These guidelines are restricted to Infections derived from the gastrointestinal tract and deal with those microorganisms commonly seen in such Infections. The recommendations are based on in vitro activity against enteric bacteria, experience in animal models, and documented efficacy in clinical trials. Other concerns regarding pharmacokinetics, mechanisms of action, microbial resistance, and safety were also used in the formation of these guidelines. For community-acquired Infections of mild to moderate severity, single-agent therapy with cefoxitin, cefotetan, or cefmetazole or ticarcillin—clavulanic acid is recommended. For more severe Infections, single-agent therapy with carbapenems (imipenem/cilastatin) or combination therapy with either a third-generation cephalosporin, a monobactam (aztreonam), or an aminoglycoside plus clindamycin or metronidazole is recommended. Regimens with little or no activity against facultative gram-negative rods or anaerobic gram-negative rods are not considered acceptable. (Arch Surg . 1992;127:83-89)
Robert G. Sawyer - One of the best experts on this subject based on the ideXlab platform.
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Aminoglycosides for intra-Abdominal Infection: equal to the challenge?
Surgical Infections, 2020Co-Authors: Jeffrey A. Bailey, Katherine S. Virgo, Joseph T. Dipiro, Avery B. Nathens, Robert G. Sawyer, John E. MazuskiAbstract:Background: Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-Abdominal Infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these Infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-Abdominal Infection. Methods: Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-Abdominal Infection were identified by MEDLINE search. For each study, data were collected regarding the number of patients enrolled and evaluated, their basic demographic characteristics, the sources of the intra-Abdominal Infections, the number of failures as determined by the study investigators, quality score, and the use of serum drug concentrat...
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age and its impact on outcomes with intra Abdominal Infection
Surgical Infections, 2017Co-Authors: Robert G. Sawyer, Ori D. Rotstein, Joseph Cuschieri, Jeffrey M Tessier, Drew Farmer, James M Sanders, E P Dellinger, Pamela A Lipsett, Preston R MillerAbstract:Abstract Background: Age has been shown to play a significant role in the etiology of complicated intra-Abdominal Infections (cIAIs), but the correlation between age and outcomes after therapy was not investigated in the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial. Patients and Methods: Data were obtained by post hoc analysis of the STOP-IT trial database. Patients were stratified by age <65 or ≥65 years. Primary outcomes were surgical site Infection (SSI), recurrent IAI (recIAI), and death. Multivariable analysis was performed to identify independent predictors of outcomes. Results: There were 398 subjects <65 and 120 ≥ 65 years. Overall baseline characteristics of the two groups were similar. The site of Infection was similar between groups except: Colon or rectum (48.3% vs. 29.9%, p = 0.0002) and biliary tree (16.7% vs. 9.1%, p = 0.02), which were more common in the older group, whereas small intestine (6.7% vs. 16.3%, p = 0.008) and appendix (4.2% vs.17.1%, p = 0.0004) were more com...
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the surgical Infection society revised guidelines on the management of intra Abdominal Infection
Surgical Infections, 2017Co-Authors: John E. Mazuski, Robert G. Sawyer, Jeffrey M Tessier, Evan P Nadler, Matthew R Rosengart, Phillip K Chang, Patrick J Oneill, Kevin P Mollen, Jared M Huston, Jose J DiazAbstract:Abstract Background: Previous evidence-based guidelines on the management of intra-Abdominal Infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the t...
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patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra Abdominal Infection
American Surgeon, 2016Co-Authors: Rishi Rattan, Robert G. Sawyer, John E. Mazuski, Casey J Allen, Therese M Duane, Reza Askari, Kaysie L Banton, Jeffrey A Claridge, Raul Coimbra, Joseph CuschieriAbstract:: A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-Abdominal Infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site Infection, recurrent intra-Abdominal Infection, extra-Abdominal Infection, and Clostridium difficile Infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site Infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-Abdominal Infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intra-Abdominal Infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.
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patients with complicated intra Abdominal Infection presenting with sepsis do not require longer duration of antimicrobial therapy
Journal of The American College of Surgeons, 2016Co-Authors: Rishi Rattan, Robert G. Sawyer, Casey J Allen, Reza Askari, Kaysie L Banton, Jeffrey A Claridge, Raul Coimbra, Christine S Cocanour, Charles H Cook, Joseph CuschieriAbstract:Background A recent prospective, multicenter, randomized controlled trial found that 4 days of antibiotics after source control of complicated intra-Abdominal Infections resulted in similar outcomes when compared with longer duration. We hypothesized that the subset of patients presenting with sepsis have similar outcomes when treated with the shorter course of antibiotics. Study Design Patients from the STOP-IT (Study to Optimize Peritoneal Infection Therapy) trial database meeting criteria for sepsis (ie, temperature 38°C and a WBC count 3 or >12,000 cells/mm 3 ) were analyzed. Patients had been randomized to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 calendar days of therapy (n = 45), or to receive a fixed short-course of antibiotics for 4 ± 1 calendar days (n = 67). Outcomes included incidence of and time to surgical site Infection, recurrent intra-Abdominal Infection, Clostridium difficile Infection, and extra-Abdominal Infections, as well as hospital days and mortality. Results One hundred and twelve of the 588 patients in the STOP-IT database met criteria for sepsis and were adherent to the protocol. With regard to short- vs long-course therapy, surgical site Infection (11.9% vs 8.9%; p = 0.759), recurrent intra-Abdominal Infection (11.9% vs 13.3%; p = 1.00), extra-Abdominal Infection (11.9% vs 8.9%; p = 0.759), hospital days (7.4 ± 5.5 days vs 9.0 ± 7.5 days; p = 0.188), days to recurrent intra-Abdominal Infection (12.5 ± 6.6 days vs 18.0 ± 8.1 days; p = 0.185), days to extra-Abdominal Infection (12.6 ± 5.8 days vs 17.3 ± 3.9 days; p = 0.194), and mortality (1.5% vs 0%; p = 1.00) were similar. There were no cases of C difficile Infection. Days to surgical site Infection (6.9 ± 3.5 days vs 21.3 ± 6.1 days; p Conclusions There was no difference in outcomes between short and long-course antimicrobial therapy in patients with complicated intra-Abdominal Infection presenting with sepsis. Our findings suggest that the presence of systemic illness does not mandate a longer antimicrobial course if source control of complicated intra-Abdominal Infection is obtained.
J M Desmonts - One of the best experts on this subject based on the ideXlab platform.
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methicillin resistant staphylococcus aureus as a causative agent of postoperative intra Abdominal Infection relation to nasal colonization
Clinical Infectious Diseases, 1999Co-Authors: Lisiane Fierobe, Dominique Decre, Claudette Muller, Jeanchristophe Lucet, Jeanpierre Marmuse, Jean Mantz, J M DesmontsAbstract:: In the surgical intensive care unit of a university hospital, we investigated the frequency of and the risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during postoperative intra-Abdominal Infection (pIAI). We conducted a prospective MRSA nasal screening and case evaluation for 17 months among 73 consecutive patients with having pIAI. MRSA pIAI was diagnosed when MRSA was obtained from culture of intraperitoneal fluids. The identity of nasal and peritoneal MRSA strains was assessed by genomic analysis. Twelve patients had MRSA pIAI, representing 21% of all MRSA Infections acquired by the 73 patients. An organ system failure score of >/=1 and MRSA nasal carriage prior to pIAI were the independent risk factors for acquisition of MRSA pIAI. Patients with MRSA pIAI had a longer intensive care unit stay and more reoperations than did those free of MRSA pIAI. We conclude that MRSA may be a causative pathogen in pIAI and may be related to nasal colonization.
David Paul Nicolau - One of the best experts on this subject based on the ideXlab platform.
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Intra-Abdominal Infections: considerations for the use of the carbapenems.
Expert Opinion on Pharmacotherapy, 2007Co-Authors: Ioannis Kioumis, Joseph Levente Kuti, David Paul NicolauAbstract:Intra-Abdominal Infection remains a common and frequently severe medical condition, carrying with it significant morbidity and mortality. These Infections are almost always polymicrobial in nature as they are caused by mixed aerobic/anaerobic intestinal flora. Despite substantial improvements in both the medical and surgical management of these Infections over the last several decades, there remains an opportunity to further enhance the utilization of adjunctive antibiotic therapy. As a result of the epidemiology and the current resistance profile of the infecting pathogens, the carbapenems represent a class of antibiotics that are considered appropriate for the treatment of severe intra-Abdominal Infections. This review will discuss the classification and microbiology of these Infections and emerging resistance in the pathogens of interest. The review also and focuses on the role of the carbapenems in the management of the constellation of diseases known as intra-Abdominal Infection.
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randomized open label comparative study of piperacillin tazobactam administered by continuous infusion versus intermittent infusion for treatment of hospitalized patients with complicated intra Abdominal Infection
Antimicrobial Agents and Chemotherapy, 2006Co-Authors: David W Mercer, Joseph Levente Kuti, David Paul Nicolau, Debra Mansfield, Kamal M F Itani, Adrian DanaAbstract:The purpose of this randomized, multicenter, open-label study was to compare the continuous infusion of piperacillin-tazobactam with the standard intermittent infusion in 262 hospitalized patients with complicated intra-Abdominal Infections. Within 1 day of surgical intervention, eligible patients were randomized (1:1) to piperacillin-tazobactam 12 g/1.5 g administered continuously over 24 h or 3 g/0.375 g administered over 30 min intermittently every 6 h for 4 to 14 days. The demographics of the patients in the groups were similar, with a median APACHE II score of 7 and a median length of hospitalization of 7 days. Among 167 clinically evaluable patients, 86.4% and 88.4% of the patients treated with the continuous infusion and the intermittent infusion, respectively, were clinically cured or improved at the test-of-cure visit (P = 0.817). Bacteriological success was observed in 83.9% and 87.9% of patients (P = 0.597) in the two groups, respectively, and no differences in bacteriological response by pathogen were noted. Defervesence and white blood cell count normalization occurred in the majority of patients within 3 days and were similar between patients receiving the continuous infusion and those receiving the intermittent infusion. Drug-related adverse events were generally mild and were reported in similar numbers of patients in each arm of the trial. The results of this study support continuous infusion as a safe and reasonable alternate mode of administration of piperacillin-tazobactam for the treatment of complicated intra-Abdominal Infection.
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population pharmacokinetics and pharmacodynamics of piperacillin tazobactam in patients with complicated intra Abdominal Infection
Journal of Antimicrobial Chemotherapy, 2005Co-Authors: Chonghua Li, Adrian Dana, Joseph Levente Kuti, Charles H. Nightingale, Debra Mansfield, David Paul NicolauAbstract:OBJECTIVES: We investigated the population pharmacokinetics and pharmacodynamics of piperacillin and tazobactam in hospitalized patients. PATIENTS AND METHODS: A multicentre, randomized clinical trial was conducted in hospitalized patients with complicated intra-Abdominal Infection. Patients received piperacillin/tazobactam administered by either continuous infusion (13.5 g over 24 h, n = 130) or intermittent infusion (3.375 g every 6 h, n = 132). NONMEM was used to perform population pharmacokinetic analysis in a subset of patients (n = 56) who had serum samples obtained at steady-state for drug concentration analyses. Classification and regression tree analysis was used to identify the breakpoints of piperacillin PK-PD indexes in 94 patients with causative pathogen's MIC. RESULTS: A one-compartment model was applied to fit the data. Creatinine clearance and body weight were the most significant variables to explain patient variability in piperacillin and tazobactam clearance and volume of distribution. The infusion method had no influence on PK parameters. For patients (n = 30) receiving intermittent infusion in the pharmacokinetic study, mean Cmax and half-life were 122.22 mg/L and 1.17 h for piperacillin, and 15.74 mg/L and 1.81 h for tazobactam. For patients (n = 26) receiving continuous infusion in the pharmacokinetic study, mean steady-state concentration was 35.31 +/- 12.15 mg/L for piperacillin and 7.29 +/- 3.28 mg/L for tazobactam. As a result of a low rate of failures (<11%) observed in the trial and the low MICs for infecting pathogens, no association could be established between clinical/microbiological outcome and drug exposure. CONCLUSIONS: Intermittent infusion and continuous infusion of piperacillin and tazobactam provided sufficient drug exposure to treat those pathogens commonly implicated in intra-Abdominal Infections.
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Population pharmacokinetics and pharmacodynamics of piperacillin/ tazobactam in patients with complicated intra-Abdominal Infection
Journal of Antimicrobial Chemotherapy, 2005Co-Authors: Chonghua Li, Debra L. Mansfield, Adrian Dana, Joseph Levente Kuti, Charles H. Nightingale, David Paul NicolauAbstract:OBJECTIVES: We investigated the population pharmacokinetics and pharmacodynamics of piperacillin and tazobactam in hospitalized patients. PATIENTS AND METHODS: A multicentre, randomized clinical trial was conducted in hospitalized patients with complicated intra-Abdominal Infection. Patients received piperacillin/tazobactam administered by either continuous infusion (13.5 g over 24 h, n = 130) or intermittent infusion (3.375 g every 6 h, n = 132). NONMEM was used to perform population pharmacokinetic analysis in a subset of patients (n = 56) who had serum samples obtained at steady-state for drug concentration analyses. Classification and regression tree analysis was used to identify the breakpoints of piperacillin PK-PD indexes in 94 patients with causative pathogen's MIC. RESULTS: A one-compartment model was applied to fit the data. Creatinine clearance and body weight were the most significant variables to explain patient variability in piperacillin and tazobactam clearance and volume of distribution. The infusion method had no influence on PK parameters. For patients (n = 30) receiving intermittent infusion in the pharmacokinetic study, mean Cmax and half-life were 122.22 mg/L and 1.17 h for piperacillin, and 15.74 mg/L and 1.81 h for tazobactam. For patients (n = 26) receiving continuous infusion in the pharmacokinetic study, mean steady-state concentration was 35.31 +/- 12.15 mg/L for piperacillin and 7.29 +/- 3.28 mg/L for tazobactam. As a result of a low rate of failures (
