Résumé
In this study, we assessed the target concentration of piperacillin (PIP) in cirrhotic and non-cirrhotic patients in the intensive care unit (ICU) receiving continuous infusion of piperacillin-tazobactam (PTZ). Our objective was also to identify the major risk factors for underdosing or overdosing and to monitor the concentration's evolution over time.Methods: this retrospective, single-center study included all patients treated with PTZ who had at least one blood level measurement of PIP. The target concentration was set at 4 to 8 times the minimum inhibitory concentration of pseudomonas aeruginosa (80-160 mg/L). Multivariate logistic regression analysis was used to evaluate factors associated with achieving the target concentration.Results: we included 348 patients in 2018 and 2020, of which 94 (27%) were cirrhotic. Among cirrhotic and non-cirrhotic patients, 37% were within the target range, 26% were underdosed, and 37% were overdosed. Renal clearance (CrCl<10 ml/min: OR=14.07; 95% CI: [6.71-29.52]; p<0.001), bilirubin levels (total bilirubin>100 µmol/L: OR=2.65 [1.26-5.56]; p<0.01), and age (age per year: OR 0.97; 95% CI [0.94-0.99]; p<0.01) were the main factors associated with incorrect dosing. During the first assay, there was no difference in concentration between cirrhotic and non-cirrhotic patients (154 mg/L (±88) vs. 161mg/L (±120) respectively; p=0.57). However, cirrhotic patients were more frequently overdosed starting from the 3rd day of treatment.Conclusion: only one-third of ICU patients treated with PTZ achieved the target concentration. Renal function, bilirubin levels, and age were associated with not reaching the target. There was no difference in the proportion of patients reaching the target concentration between patients with and without cirrhosis during the initial measurement.