Nosocomial pneumonia (NP) is one of the most frequently occurring infections among hospitalized patients which usually manifests within 48 hours of hospitalization.1 It is the major cause of mortality attributable to hospital acquired infections.2 According to the National Nosocomial Infections Surveillance system (NNIS) of the United States, it is considered as the second most common nosocomial infection in intensive care units (ICUs). Researchers have suggested that the prevalence of NP in the ICU varies from 9–24% with variation relating to the intensive care and 3 the diagnostic techniques used. Besides, the mortality 4 related to NP ranges from 3-17%. There is a wide variety of organisms associated with NP including aerobic and anaerobic Gram-positive cocci and Gram-negative bacilli.5 The organisms commonly found to be associated are Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter species, and Enterobacter species, with lesser prevalence of Serratia species, Stenotrophomonas maltophilia, and community-acquired pathogens including Pneumococci and Hemophilus influenza.6 Besides, there is an increased prevalence of methicillin-resistant strains of Staphylococcus aureus (MRSA), which warrants the need for an up-to-date clinical assessment.7,1 However the diagnosis of NP is a great challenge for the clinicians and the use of invasive techniques remains contentious. A guideline has been projected which aids in the diagnosis of NP. According to the guideline NP should be suspected in all the patients who meet any two of the following three criteria: leukocyte count above 10,000 or below 4,000/µL, temperature above 38.3°C, presence of purulent respiratory discharge and decreased partial pressure of oxygen in arterial blood (PaO2).
Additionally, the risk assessment of the patient should be based upon the clinical presentation, time of onset following admission to the hospital, and the probability for resistant pathogens.
Moreover, cost related to NP imposes a huge economic burden over the society, which thereby imposes a need for proper diagnosis, management and prevention strategies.
Management of NP involves a specific approach based on the severity of illness upon clinical presentation and presence or absence of risk factors for the particular bacterial pathogens. The core of this specific approach is formed by the selection of broad spectrum antimicrobial drugs. In this context piperacillin/ tazobactam combination is preferred in patients with high risk of developing resistance. Piperacillin / tazobactam combination is a broad-spectrum β-lactam-β-lactamase inhibitor antibiotic combination used for the treatment of critically ill patients with NP. A study11 was conducted to compare the efficacy of piperacillin/ tazobactam with that of meropenem in NP patients. The patients were allocated to receive either piperacillin/ tazobactam at a dose of 13.5 g/day or meropenem g/day. The result revealed that clinical cure rate with piperacillin/tazobactam was 75.9 % while that with meropenem was 64.3%. Moreover, the clinical efficacy and bacteriological eradication rates were 87.9 %, 94.4% with piperacillin/tazobactam and 74.2%, 87.5% with meropenem, respectively.
Furthermore, piperacillin/tazobactam prolonged infusion time has more stable plasma concentration, curative clinical effect and reduced cost of treatment. This was validated by a study13 which evaluated the clinical efficacy of piperacillin / tazobactam prolonged infusion time in treatment of NP. A total number of 50patients were enrolled in the study, which were divided into treatment group and control group. The therapeutic regimen in control and treatment group was piperacillin/ tazobactam 4.5 g regular infusion every 6 hours, and piperacillin/tazobactam 4.5 g, in prolonged infusion every 6 hours by using infusion pump for continuous IV infusion, respectively. The acute physiology and chronic health evaluation II (APACHEII) score, clinical pulmonary infection score (CPIS) and procalcitonin (PCT) level were compared between the two groups 3 days after therapy. The results revealed that PCT, CPIS, and remedial treatment rate were significantly lower and (APACHEII) score was higher in the treatment group compared to control group.
An appraisal of aforementioned data suggests that piperacillin/ tazobactam is indeed a potent agent and provide fruitful results in the management of nosocomial pneumonia.
Nosocomial pneumonia is one of the major causes of mortality among hospitalized patients. There are a wide variety of bacteria associated with this infection including aerobic and anaerobic Gram-positive cocci and Gram-negative bacilli. Piperacillin / tazobactam is a broad spectrum -lactam--lactamase inhibitor antibiotic used for the treatment of critically ill patients with NP. Several studies are indicative of its efficacy and safety in the management of nosocomial pneumonia.