Can changes in renal function predict variations in ¦Â-lactam concentrations in septic patients?

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• 作者：Giuseppe Stefano Casu ; Maya Hites ; Frederique Jacobs ; Frederic Cotton ; Fleur Wolff ; Marjorie Beumier ; Daniel De Backer ; Jean-Louis Vincent ; Fabio Silvio Taccone
• 关键词：¦Â-Lactams ; Creatinine clearance ; Sepsis ; Critically ill ; Pharmacokinetics
• 刊名：International Journal of Antimicrobial Agents
• 出版年：2013
• 出版时间：November, 2013
• 年：2013
• 卷：42
• 期：5
• 页码：422-428
• 全文大小：795 K

文摘

This study investigated whether variations in creatinine clearance (CL_Cr) are correlated with changes in ¦Â-lactam concentrations or pharmacokinetics in septic patients. Data for 56 adult patients admitted to the ICU in whom routine therapeutic drug monitoring (TDM) of broad-spectrum ¦Â-lactams (ceftazidime, cefepime, piperacillin or meropenem) was performed were reviewed. Patients were included if they had at least two TDM during their ICU stay for the same antibiotic and were not concomitantly treated with any extracorporeal replacement therapy. Serum drug concentrations were measured by HPLC-UV. Antibiotic pharmacokinetics were calculated using a one-compartment model and the percentage of time spent above four times the MIC ( % T > 4 ¡Á MIC) for Pseudomonas aeruginosa and the antibiotic clearance (ATB-CL) were obtained. CL_Cr was measured on the same day as the TDM using 24-h urine collection. The % T > 4 ¡Á MIC and ATB-CL were significantly correlated with CL_Cr at the first (r = ?0.41, P = 0.002; r = 0.56, P < 0.001, respectively) and second (r = ?0.61, P < 0.001; r = 0.63, P < 0.001, respectively) TDM. However, changes in ATB-CL were only weakly correlated with changes in CL_Cr (r = 0.34, P = 0.01). The proportion of patients with insufficient ¦Â-lactam concentrations at the first and second TDM were 39 % and 30 % , respectively, and increased proportionally to CL_Cr. Although CL_Cr was significantly correlated with concentrations and clearance of broad-spectrum ¦Â-lactams, changes in CL_Cr did not reliably predict variations in drug pharmacokinetics/pharmacodynamics. Routine TDM should be considered to adapt ¦Â-lactam doses in this setting.