Details

Autor(en) / Beteiligte

• Carrié, Cédric
• Legeron, Rachel
• Petit, Laurent
• Ollivier, Julien
• Cottenceau, Vincent
• d'Houdain, Nicolas
• Boyer, Philippe
• Lafitte, Mélanie
• Xuereb, Fabien
• Sztark, François
• Breilh, Dominique
• Biais, Matthieu

Titel

Higher than standard dosing regimen are needed to achieve optimal antibiotic exposure in critically ill patients with augmented renal clearance receiving piperacillin-tazobactam administered by continuous infusion

Ist Teil von

• Journal of critical care, 2018-12, Vol.48, p.66-71

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• To determine whether augmented renal clearance (ARC) impacts negatively on piperacillin-tazobactam unbound concentrations in critically ill patients receiving 16 g/2 g/day administered continuously. Fifty nine critically ill patients without renal impairment underwent 24-h creatinine clearance (CrCL) measurement and therapeutic drug monitoring during the first three days of antimicrobial therapy by piperacillin-tazobactam. The main outcome was the rate of piperacillin underexposure, defined by at least one of three samples under 16 mg/L. Monte Carlo simulation was performed to predict the distribution of piperacillin concentrations for various CrCL and minimal inhibitory concentration (MIC) values. The rate of piperacillin underexposure was 19%, significantly higher in ARC patients (0 vs. 31%, p = .003). A threshold of CrCL ≥ 170 mL/min had a sensitivity and specificity of 1 (95%CI: 0.79–1) and 0.69 (95%CI: 0.61–0.76) to predict piperacillin underexposure. In ARC patients, a 20 g/2.5 g/24 h PTZ dosing regimen was associated with the highest probability to reach the 16 mg/L empirical target, without risk of excessive dosing. When targeting a theoretical MIC at the upper limit of the susceptibility range, the desirable target (100%fT>16) may not be achieved in patients with CrCL ≥ 170 mL/min receiving PTZ 16 g/2 g/day administered continuously. •Continuous infusion of piperacillin 16 g/day is inadequate in patients with augmented renal clearance•A 20 g/2.5 g/24 h dosing regimen is best suitable when targeting for empirical antibiotic therapy This increased regimen is not associated with excessive dosing in patients with ARC