| Objective To explore the factors affecting the plasma concentration of piperacillin obtained after piperacillin/tazobactam treatment in patients with sepsis within the Intensive Care Unit(ICU). Methods The clinical data of 82 patients with sepsisadmitted to the ICU of Huangshan Hospital from August 2020 to March 2022 were retrospectively analyzed, and the patients received a regular dose of piperacillin/tazobactam of 4.5g(piperacillin 4 g/tazobactam 0.5 g), with simultaneous monitoring of piperacillin concentrations.The 82 cases met the inclusion criteria.According to the therapeutic drug monitoring(TDM),they were divided into standard group(n=34) and substandard group(n=48).Multiple logistic regression analysis was conducted to screen the influencing factors of insufficient piperacillin concentration in blood, and the predictive value of risk factors was analyzed by the receiver operating characteristic curve(ROC) of the subjects. Results The univariate analysis revealed that age,body mass index(BMI),trauma, surgery,acute physiology and chronic health score Ⅱ(APACHE Ⅱ), sequential organ failure(sofa) score,creatinine clearance rate(CrCl) were statistically significant(all P<0.05).Multiple logistic regression showed that BMI(OR=1.611,95% CI:1.069~2.427) and CrCl(OR=1.249,95% CI:1.059~1.474) were independent risk factors for insufficient piperacillin concentration(all P<0.05).The area under the curve(AUC) of BMI predicting insufficient piperacillin concentration was 0.784,the optimal cut-off value was 20.78 kg/m2,the sensitivity was 83.3% and thespecificity was 73.5%. The AUC of CrCl was 0.975 and the best cut-off value was 41.62 mL/min,the sensitivity was 97.9%,and the specificity was 88.2%. Conclusions For ICU patients with sepsis,BMI and CrCl are independent risk factors for piperacillin drug concentration,and both are inversely correlated with drug concentration and have good predictive value,while CrCl has a higher predictive value for piperacillin drug concentration. |
