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PubMed1994

Susceptibilities of 200 penicillin-susceptible and -resistant pneumococci to piperacillin, piperacillin-tazobactam, ticarcillin, ticarcillin-clavulanate, ampicillin, ampicillin-sulbactam, ceftazidime, and ceftriaxone.

MICs of eight beta-lactams (piperacillin, piperacillin-tazobactam, ticarcillin, ticarcillin-clavulanate, ampicillin, ampicillin-sulbactam, ceftazidime, and ceftriaxone) were determined by agar dilution against 64 penicillin-susceptible, 70 intermediately penicillin-resistant, and 66 fully penicillin-resistant pneumococci. The MICs of piperacillin with and without tazobactam for 90% of the susceptible, intermediately resistant, and resistant strains tested (MIC90s) were < or = 0.064, 2.0, and 4.0 micrograms/ml, respectively. By comparison, those of ampicillin with and without sulbactam were 0.125, 2.0, and 4.0 micrograms/ml and those of ceftriaxone were < or = 0.064, 1.0, and 2.0 micrograms/ml, respectively. Strains were less susceptible to ticarcillin with and without clavulanate (MIC90s, 2.0, 64.0, and 128.0 micrograms/ml) and ceftazidime (MIC90s, 1.0, 8.0, and 32.0 micrograms/ml).

Ampicillin↗
PubMed2001

Evaluating possible pharmacokinetic interactions between tobramycin, piperacillin, and a combination of piperacillin and tazobactam in patients with various degrees of renal impairment.

A study was performed to further investigate the apparent instability of tobramycin when coadministered with piperacillin/tazobactam in subjects with renal impairment. Twenty-six otherwise healthy volunteers between 23 and 74 years of age were studied. Eight subjects had moderate renal impairment, 10 had mild renal impairment, and 8 had normal renal function. Each subject received single doses of piperacillin/tazobactam and tobramycin alone as well as combined doses in a randomized, three-way crossover design. The subjects with normal renal function also received combined doses of piperacillin and tobramycin. Considerable care was taken to protect against in vitro inactivation of plasma and urine samples after collection. No systematic changes in pharmacokinetic parameters were observed. It is concluded that piperacillin, either alone or with tazobactam, did not change the pharmacokinetics of tobramycin in subjects with renal impairment. The apparent in vivo inactivation of tobramycin in the presence of piperacillin or piperacillin/tazobactam reported by others may be an artifact of ex vivo inactivation.

Adult↗
PubMed2005

Piperacillin-sulbactam versus piperacillin-tazobactam: a multicentre, randomised, single-blind, controlled clinical trial.

The objective of this study was to compare the efficacy and safety of piperacillin-sulbactam (PIP-SBT) and piperacillin-tazobactam (PIP-TAZ) in the treatment of bacterial respiratory and urinary tract infections. A randomised, single-blind, controlled clinical trial was performed. Differences in clinical efficacy, bacteriology and safety between the two groups were subjected to statistical analysis, including intent-to-treat (ITT) analysis. A total of 215 cases were enrolled, with 203 complete cases (99 PIP-SBT, 104 PIP-TAZ). A total of 209 cases (103 PIP-SBT, 106 PIP-TAZ) were included in the ITT analysis and a total of 212 cases (104 PIP-SBT, 108 PIP-TAZ) were included in the safety analysis. Overall efficacy rates of PIP-SBT and PIP-TAZ were 93.2% and 93.4%, respectively. Overall bacterial eradication rates of the two groups were 95% and 97.59%, respectively. Among the PIP-SBT group, eight patients (7.69%) had adverse events, including four probable drug-related events. Among the PIP-TAZ group, nine patients (8.33%) had adverse events, including one definitely drug-related and four probable drug-related events. All differences between the two groups were insignificant. PIP-SBT could be a suitable replacement for PIP-TAZ in the therapy of community-acquired respiratory and urinary tract infections caused by beta-lactamase-producing bacterial isolates.

Adult↗
PubMed1997

The formation of desethyl-piperacillin from piperacillin by human liver S9 in vitro.

Piperacillin (PIPC) has been used as one of the most useful beta-lactam antibiotics over the past 10 years. The metabolism of PIPC has been thoroughly investigated and it has been recognized that PIPC gives few metabolites in laboratory species or humans. Recently, an active metabolite, desethyl-piperacillin (DEt-PIPC), was detected in human plasma and urine after PIPC administration. In the current study, human tissues were obtained from organ donors (n = 3) and subcellular fractions (S9) were prepared. The time course of metabolism by S9 mix from liver, kidney cortex, and kidney medulla was then determined using 0.5 mM PIPC. For comparative purposes, rat liver S9 were also prepared and incubated with PIPC under the same conditions. DEt-PIPC was formed by human liver S9 mix from all three specimens studied, with the rate varying approximately eightfold. No DEt-PIPC was detected in any of the incubations with rat liver S9 mix (n = 3) and kidney S9 mix (n = 3) prepared from either the cortex or medulla. In summary, these data suggest that the formation of the unique human metabolite, DEt-PIPC, can be predicted by in vitro studies with human tissues and that this metabolite is formed predominantly by the liver.

Adult↗
PubMed2002

Pseudomonas aeruginosa ventilator-associated pneumonia: comparison of episodes due to piperacillin-resistant versus piperacillin-susceptible organisms.

We sought to determine the epidemiological characteristics of patients in an intensive care unit (ICU) who developed ventilator-associated pneumonia (VAP) caused by piperacillin-resistant Pseudomonas aeruginosa (PRPA; n=34) or piperacillin-susceptible P. aeruginosa (PSPA; n=101). According to univariate analysis, the factors associated with the development of PRPA VAP were presence of an underlying fatal medical condition, immunocompromised status, longer previous hospital stay, less-severe illness at the time of ICU admission, duration of mechanical ventilation before onset of VAP, number of classes of antibiotic received, and previous exposure to imipenem or fluoroquinolone. Multivariate logistic regression analysis identified the following significant independent factors: presence of an underlying fatal medical condition (odds ratio [OR], 5.6), previous fluoroquinolone use (OR, 4.6), and initial disease severity (OR, 0.8). We concluded that the clinical characteristics of patients who develop PRPA VAP differ from those of patients who develop PSPA VAP. Restricted fluoroquinolone use is the sole independent risk factor for PRPA VAP that is open to medical intervention.

Aged↗
PubMed1992

Piperacillin plus amikacin vs. piperacillin plus amikacin plus teicoplanin for empirical treatment of febrile episodes in neutropenic patients receiving quinolone prophylaxis.

A prospective, randomized trial was initiated to evaluate the efficacy of two antibiotic regimens, differing in the agent included with activity against gram-positive bacteria, for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies (group 1, piperacillin plus amikacin; group 2, piperacillin plus amikacin plus teicoplanin). After 72 hours of therapy, patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B. A total of 158 evaluable episodes were observed within 8 months. The success rate was 50.6% in group 1 and 60% in group 2. The response rate among patients who did not respond to the original regimen increased to 86.7% with the addition of teicoplanin (group 1) and to 90% with the addition of amphotericin B (group 2). There were 86 unexplained febrile episodes and 56 documented episodes of bacteremia (34 caused by gram-positive organisms). Our results indicate that teicoplanin is safe, well tolerated, and effective for the treatment of documented episodes of gram-positive bacteremia and as an empirical agent. The inclusion of teicoplanin in the initial empirical regimen appears unnecessary if a combination of antibiotics active against gram-positive organisms is used, unless infections are due to oxacillin-resistant staphylococci.

4-Quinolones↗
PubMed1990

[Medical treatment of pelvic inflammatory disease. A clinical study on the therapeutic effectiveness of piperacillin + erythromycin and of piperacillin + clindamycin + gentamycin].

The aim of the present clinical study was to evaluate the therapeutic effectiveness of two different antibiotic combinations (piperacillin + erythromycin and piperacillin + clindamycin + gentamycin) in the medical treatment of patients with pelvic inflammatory disease, respectively at the II and III stage. The findings confirm the therapeutic value and the low toxicity of both pharmacological regimens.

Clindamycin↗
PubMed2004

Comparative study of the effects of ceftizoxime, piperacillin, and piperacillin-tazobactam concentrations on antibacterial activity and selection of antibiotic-resistant mutants of Enterobacter cloacae and Bacteroides fragilis in vitro and in vivo in mixed-infection abscesses.

The effects of ceftizoxime (CZX), piperacillin (PIP), and PIP-tazobactam (PT) concentrations on the antibacterial activity and selection of resistant mutants of Bacteroides fragilis and Enterobacter cloacae were investigated in vitro in a mixed-culture anaerobic time-kill study and in vivo in a mixed-infection abscess model. Mixed cultures were incubated for 24 h with 0.125 to 512 micro g of CZX per ml or 0.125 to 2,048 micro g of PIP or PT per ml. Mice were treated every 2 h for 24 h with CZX at 6 to 1,536 mg/kg/day or with PIP or PT at 24 to 6,144 mg/kg/day starting 30 min before inoculation with different B. fragilis-E. cloacae combinations. There was a good correlation between the in vitro and in vivo activities of the antibiotics and their MICs obtained with high inocula (10(8) CFU/ml). The respective 50% effective doses (milligrams per kilogram per day) with B. fragilis and E. cloacae 22491 were 771 and 521 for CZX, 416 and 643 for PIP, and 85 and 554 for PT, and with the B. fragilis-E. cloacae 032349 combination, they were 81 and 21 for CZX and 77 and 766 for PT. Resistant mutants of E. cloacae 22491 were preferentially selected in vitro with 2 to 64 micro g of CZX per ml and in vivo with CZX at 12 to 384 mg/kg/day. There was no preferential selection of CZX-resistant B. fragilis or E. cloacae 032349. For CZX-resistant E. cloacae 22491, we found a 16- to 512-fold increase in the MIC of CZX and increased MICs of other expanded-spectrum cephalosporins, owing in part to the production of a stably derepressed cephalosporinase. In vitro and in vivo, PT did not select resistant mutants of E. cloacae and B. fragilis. Results demonstrate the adverse microbiological outcome of choosing an expanded-spectrum cephalosporin like CZX for empirical treatment of mixed infections involving a susceptible Enterobacter strain.

Abscess↗
PubMed1986

Pharmacokinetic studies on the concomitant administration of piperacillin and cefazolin, and piperacillin and cefoperazone in rabbits.

The pharmacokinetics of each drug on the concomitant administration of piperacillin (PIPC) and cefazolin (CEZ) or cefoperazone (CPZ) were studied in rabbits. When rabbits received the consecutive drip infusion administration of CEZ (0.71 mg/kg/minute) and PIPC (1.38 mg/kg/minute) and likewise of CPZ (0.72 mg/kg/minute) and PIPC (1.54 mg/kg/minute) for 1 hour, respectively, the serum half-lives of CEZ and CPZ were respectively prolonged about 1.8 and 1.6 times during drip infusion of PIPC than administered alone. However, when the sequence of administration were reversed, the serum levels of PIPC were not affected by the consecutive drip infusion administration of CEZ and CPZ. To study these findings in detail, the single intravenous dose of 20 mg/kg of CEZ and CPZ were administered under drip infusion of PIPC (2.65-2.93 mg/kg/minute). The serum half-lives of CEZ and CPZ were also prolonged about 5.4 and 1.9 times, respectively, whereas urinary excretion of CEZ, and urinary and biliary excretion of CPZ were reduced by PIPC. Moreover, when the single intravenous dose of 20 mg/kg of PIPC were administered under drip infusion administration of CEZ (0.96-2.60 2.60 mg/kg/minute), the pharmacokinetics of PIPC was not affected by the presence of CEZ. However, under drip infusion administration of CPZ (2.60-2.70 mg/kg/minute), the PIPC serum half-life was prolonged about 1.4 times, and biliary excretion of PIPC was reduced but urinary excretion was not. From the results of renal clearance experiments, tubular secretion appeared to be the predominant mechanism of renal elimination for these three drugs. These results indicate that PIPC influences the pharmacokinetics of both drugs by the competitively inhibiting tubular secretion in CEZ, and tubular secretion and hepatic transport system in CPZ. Therefore, in this respect PIPC seems to have probenecid-like action.

Animals↗
PubMed1984

[Studies on tissue concentrations of cefoperazone and piperacillin classified by the site of the wall of gallbladder and concentration of piperacillin in the bile after operation].

In selection of drugs to be used in the treatment of biliary tract infections, sensitivity of causative organisms to drugs and tissue concentrations of the drugs constitute important factors. In the present study we treated patients with cholelithiasis with cefoperazone (CPZ) and piperacillin (PIPC), both of which have been reported to show high concentrations in the bile, and concentrations of the drugs in serum, cholecystic bile and various sites of the wall of gallbladder were determined. In addition the drug concentrations in the serum and bile at the 1st and 7th postoperative days were also determined. The following results were obtained. Comparison of concentrations of CPZ and PIPC at various sites of the wall of gallbladder revealed that both drugs showed high levels in the bottom, body and neck areas of the gallbladder with no difference by sites. The concentration ratios against serum for these drugs were 71.8 and 83.6%, showing good transference into tissue. The mean concentrations of CPZ and PIPC in the cholecystic bile were as high as 448.8 and 381.6 micrograms/ml, the ratio against serum being about 4:1. The serum concentrations of PIPC at the 1st and 7th postoperative days were 116 and 137 micrograms/ml at 60 minutes after starting drip infusion, with no difference between these 2 days. In the bile concentrations of PIPC on both postoperative days showed the peak levels of 2,587 and 1,157 micrograms/ml at 120 minutes after starting drip infusion. The concentrations at the 1st postoperative day were higher. The recovery rate of PIPC from the bile was also higher at the 1st postoperative day. From the results that both drugs showed high levels in the wall of gallbladder and also showed high levels in the bile immediately after the operation, PIPC and CPZ are considered to be effective drugs for biliary tract infections.

Bile↗
PubMed1984

Transfer of piperacillin to various uterine tissues. Piperacillin study group for application in the field of obstetrics and gynecology.

As part of our series of fundamental studies on the application of piperacillin (PIPC) in the gynecologic field, we studied the transfer of PIPC to the uterine tissues. During our pharmacokinetic study of PIPC, a two-compartment model was used for blood levels: C1 = Ae-beta t + Be-alpha t. A three-compartment model was applied for the levels in the various uterine tissues and the retroperitoneum; C3 = A'e-beta t + B'e-alpha t + Ce-K31t. PIPC showed rapid transfer to the various uterine tissues and its disappearance rate developed parallel to decreases in blood concentrations. Although its transfer to the retroperitoneum was relatively rapid, since there was a clear delay in time required for the drug concentration to reach its peak (C max), the existence of a third compartment was conjectured. From the correlation between the MIC80 and the drug concentrations in the various uterine tissues and the retroperitoneum, it was found that effective doses were maintained in the uterine tissues for 3-5 h and in the retroperitoneum for 8-19 h. Thus, adequate clinical efficacy could be anticipated during administration of PIPC.

Female↗
PubMed1996

Susceptibilities of non-Pseudomonas aeruginosa gram-negative nonfermentative rods to ciprofloxacin, ofloxacin, levofloxacin, D-ofloxacin, sparfloxacin, ceftazidime, piperacillin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and imipenem.

Agar dilution MICs of 10 agents against 410 non-Pseudomonas aeruginosa gram-negative nonfermentative rods were determined. MICs at which 50 and 90% of the isolates were inhibited, respectively, were as follows (in micrograms per milliliter): sparfloxacin, 0.5 and 8.0; levofloxacin, 1.0 and 8.0; ciprofloxacin, 2.0 and 32.0; ofloxacin, 2.0 and 32.0; D-ofloxacin, 32.0 and > 64.0; ceftazidime, 8.0 and 64.0; piperacillin with or without tazobactam, 16.0 and > 64.0; trimethoprim-sulfamethoxazole, 0.5 and > 64.0; imipenem, 2.0 and > 64.0. With the exception of those for Stenotrophomonas maltophilia, Burkholderia cepacia, and Alcaligenes faecalis-A. odorans, agar dilution MICs for all strains tested were within 1 dilution of inhibitory (bacteriostatic) levels as determined by time-kill methodology.

Anti-Bacterial Agents↗
PubMed1992

Pharmacokinetics and tissue penetration of tazobactam and piperacillin in patients undergoing colorectal surgery.

The pharmacokinetics of tazobactam and piperacillin in plasma and different tissues after a 30-min intravenous infusion of 4 g of piperacillin and 0.5 g of tazobactam were investigated in 18 patients who underwent elective colorectal surgery. Serial blood samples were collected for up to 6 h after the initiation of the infusion. The types of tissue collected were fatty tissue, muscle, skin, appendix, and intestinal mucosa (proximal and distal). On the basis of concentrations in plasma, the following pharmacokinetic parameter values were obtained (values are means +/- standard deviations): maximum concentration of drug in serum, tazobactam, 27.9 +/- 7.67 micrograms/ml; piperacillin, 259 +/- 81.8 micrograms/ml; time to maximum concentration of drug in serum, tazobactam, 0.51 +/- 0.03 h; piperacillin, 0.51 +/- 0.03 h; area under the concentration-time curve, tazobactam, 47.6 +/- 13.3 micrograms.h/ml; piperacillin, 361 +/- 80.3 micrograms.h/ml; clearance, tazobactam, 188 +/- 52.3 ml/min; piperacillin, 194 +/- 42.9 ml/min; half-life, tazobactam, 1.42 +/- 0.32 h; piperacillin, 1.27 +/- 0.24 h; apparent volume of distribution, tazobactam, 0.31 +/- 0.07 liter/kg of body weight; piperacillin, 0.29 +/- 0.06 liter/kg; volume of distribution at steady state, tazobactam, 0.28 +/- 0.04 liter/kg; piperacillin, 0.25 +/- 0.05 liter/kg. The concentrations of tazobactam and piperacillin in fatty tissue and muscle tissue were 10 to 13 and 18 to 30% of the levels in plasma, respectively. In skin, the concentrations of piperacillin were 60 to 95% of the levels in plasma, whereas the concentrations of tazobactam in plasma were 49 to 93% of the levels in skin tissue. The mean concentration of tazobactam in the investigated gastrointestinal tissues (appendix, proximal and distal mucosa) exceeded levels in plasma after 1 h, while piperacillin showed a mean penetration into these tissues of 43 and 53%. The mechanisms that can be used to explain the extent of penetration of piperacillin and tazobactam are discussed. Simple diffusion may take place in fatty and muscle tissue, while penetration into skin and gastrointestinal tissue is governed by more complex mechanisms which lead to differences in penetration between piperacillin and tazobactam. For all tissues investigated (except fatty tissue), the time course of the concentrations of both compounds was similar, with a peak in concentration at between 1 and 2 h after the start of infusion followed by a decline of concentrations that were almost parallel to the curves of the drug concentrations in plasma. In plasma and in all investigated tissues, piperacillin as well as tazobactam reached or exceeded the concentrations found to be effective in vitro.

Adipose Tissue↗
PubMed1993

Ex vivo pharmacodynamic study of piperacillin alone and in combination with tazobactam, compared with ticarcillin plus clavulanic acid.

Ten volunteers received piperacillin (4 g), piperacillin (4 g) plus tazobactam (0.5 g) (Tazocin), and ticarcillin (3 g) plus clavulanic acid (0.2 g) (Timentin) intravenously over 30 min in a cross-over blinded scheme. Blood samples were obtained 0.5 and 3 h after the end of infusion to measure by (high-pressure liquid chromatography) the concentration and bactericidal titers against 70 gram-negative bacilli. Serum time-kill curves were done against 35 strains to measure killing rates and area under the time-kill curve. Using the measure of serum bactericidal activity, ticarcillin-clavulanic acid and piperacillin-tazobactam were equally effective against Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Serratia marcescens, and Bacteroides fragilis. Piperacillin-tazobactam was superior to ticarcillin-clavulanic acid against piperacillin-resistant Klebsiella pneumoniae (4 to 16 times) and S. marcescens (2 to 4 times). By using the area under the time-kill curve, piperacillin-tazobactam was equivalent to ticarcillin-clavulanic acid against piperacillin-susceptible strains; piperacillin-tazobactam was significantly more active than piperacillin against piperacillin-resistant strains and was more active than ticarcillin-clavulanic acid when the sample obtained 3 h after the end of infusion to volunteers was considered. Serum piperacillin concentrations (mean +/- standard error of the mean; in mg/liter) were 115 +/- 13 at 0.5 h and 7.4 +/- 1.4 at 3 h after the administration of piperacillin alone and 105.5 +/- 12.6 (0.5 h) and 7.7 +/- 1.6 after the administration of piperacillin-tazobactam. Serum tazobactam concentrations (in milligram per liter) were 13.1 +/- 1.4 at 0.5 h and 1.2 +/- 0.2 at 3 h. The piperacillin-tazobactam ratio was 8 +/- 0.3 at 0.5 h and 6.2 +/- 0.5 at 3 h. Piperacillin-tazobactam appears promising against beta-lactamase-producing gram-negative bacilli.

Adult↗
PubMed1993

Susceptibility of beta-lactamase-producing enterococci to piperacillin with tazobactam.

The in vitro activity of piperacillin with and without tazobactam was evaluated against different inocula of 12 clinical isolates of beta-lactamase-producing Enterococcus faecalis obtained from different geographic areas. Minimum inhibitory concentrations (MICs) of piperacillin alone at approximately 10(3) colony-forming units (CFU)/spot ranged from 4 to 8 and from 4 to 8 micrograms/ml with piperacillin plus tazobactam. When approximately 10(7) CFU/spot was used, MICs increased to a range of 128-1024 micrograms/ml piperacillin. This inoculum effect was reversed by the addition of tazobactam to piperacillin at a fixed concentration of 1 microgram/ml or at a ratio of 8 : 1 (piperacillin relative to tazobactam) with an MIC90 of 16/2 micrograms/ml for the combination drug. In time-kill studies, four beta-lactamase-producing (Bla+) isolates were tested and demonstrated a decrease of > or = 2 log10 with 8 or 16 micrograms/ml of piperacillin in combination with 4 micrograms of tazobactam, but not with piperacillin alone. A non-beta-lactamase-producing isolate was equally inhibited by piperacillin alone and piperacillin plus tazobactam. Against a Bla+ isolate, the combination of piperacillin with tazobactam with streptomycin resulted in a synergistic effect relative to that of piperacillin with tazobactam; piperacillin plus streptomycin did not show synergism. Piperacillin in combination with tazobactam is active against enterococci that produce beta-lactamase and, in combination with an appropriate aminoglycoside, could be a viable choice for therapy of enterococci that do not have high-level resistance to all aminoglycosides.

Culture Media↗
PubMed2002

Risk factors for piperacillin-tazobactam-resistant Pseudomonas aeruginosa among hospitalized patients.

Antimicrobial resistance is an emerging problem with Pseudomonas aeruginosa. This study determined risk factors for the recovery of piperacillin-tazobactam-resistant P. aeruginosa from clinical cultures from hospitalized patients. A case-control study design was used to compare two groups of case patients with control patients. The first group of case patients was defined by nosocomial isolation of piperacillin-tazobactam-resistant P. aeruginosa, and the second group of cases yielded piperacillin-tazobactam-susceptible P. aeruginosa. Controls were selected in a 6:1 ratio from the same medical or surgical services among which piperacillin-tazobactam-resistant P. aeruginosa arose in patients. Risk factors analyzed included antimicrobial drug exposure, comorbid conditions, and demographics. Bivariate and multivariable analyses were performed. Piperacillin-tazobactam-resistant P. aeruginosa was isolated from 179 patients, and piperacillin-tazobactam-susceptible P. aeruginosa was isolated from 624 patients over a 2.5-year period. Piperacillin-tazobactam (odds ratio [OR] = 6.82; 95% confidence interval [CI], 4.56 to 10.21), imipenem (OR = 2.42; 95% CI, 1.19 to 4.94), aminoglycosides (OR = 2.18; 95% CI, 1.44 to 3.28), vancomycin (OR = 1.87; 95% CI, 1.21 to 2.89), and broad-spectrum cephalosporins (OR = 2.38; 95% CI, 1.45 to 3.88) were the antibiotics associated with the isolation of piperacillin-tazobactam-resistant P. aeruginosa. Exposure to vancomycin (OR = 1.53; 95% CI, 1.13 to 2.06) or ampicillin-sulbactam (OR = 2.28; 95% CI, 1.62 to 3.21) was associated with recovery of piperacillin-tazobactam-susceptible P. aeruginosa. In this study, antibiotics associated with piperacillin-tazobactam-susceptible P. aeruginosa were different from antibiotics associated with piperacillin-tazobactam-resistant P. aeruginosa. Piperacillin-tazobactam was a strong risk factor for piperacillin-tazobactam-resistant P. aeruginosa. Our results suggest that the nosocomial isolation of piperacillin-tazobactam-resistant P. aeruginosa may be affected by multiple antibiotics.

Adult↗