Adverse Events Associated to Piperacillin-Tazobactam Use in Children With Cystic Fibrosis
Bibliographic record
Abstract
Background. Pulmonary exacerbations—where P. aeruginosa plays an important role—are the leading cause of morbidity and mortality in patients suffering from cystic fibrosis (CF). Although intravenous piperacillin/tazobactam (PT) treatment is widely used, it is perceived as causing adverse events (AE) at a greater frequency and severity than other β-lactams. We aimed to understand the characteristics of children with CF who developed AEs to PT. Methods. The CF clinic at the Montreal Children's Hospital follows a cohort of 80 children. We retrieved all admissions for children with CF (pulmonary exacerbations) from 1990 to April 2013 and crossed the admissions with the pharmacy-dispensing database to select admissions where PT was prescribed. Charts from patients who had received at least one course of PT (lifetime) were reviewed. Using a standardized case report form, we collected data from each admission including demographic, clinical, treatment and outcomes characteristics. PT AEs were defined as follows: fever or rash or serum sickness-like reaction (≥3 of fever, arthralgia or arthritis, urticarial rash, lymphadenopathy, or nausea/vomiting) that occurred after treatment onset. Results. Of 25 patients and 43 admissions included in the study, 5 patients (20% of patients, 11.6% of admissions) demonstrated a possible PT-induced AE; 4 patients (16% of patients, 9.3% of admissions) experienced fever, 3 patients (12% of patients, 7.0% of admissions) experienced rash, and 1 patient (4% of patients, 2.3% of admissions) experienced serum sickness with febrile neutropenia (leukopenia preceded fever). The patient experiencing serum sickness received a statistically higher dose of PT than those who did not experience serum sickness (600 versus 265.8 mg/kg per day, above 99.7th confidence interval). Patients experiencing rash also tended to be receiving higher doses of PT (322 versus 271.5 mg/kg per day) but had lower previous exposure to PT (163.5 versus 256.0 mg/kg per day, p = 0.0147). Conclusion. There may be a need to limit the dose of PT administered to patients with CF and optimize pharmacodynamics properties of PT (prolonged infusion). Comparing the relative risk of AEs between PT and other β-lactams in this population is needed. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".