Applying Cefepime Population Pharmacokinetics to Critically Ill Patients Receiving Continuous Renal Replacement Therapy.

Autor: Al-Shaer MH; Infectious Disease Pharmacokinetics Laboratory, Emerging Pathogens Institute, University of Floridagrid.15276.37, Gainesville, Florida, USA.; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Floridagrid.15276.37, Gainesville, Florida, USA., Maguigan K; Pharmacy Department, University of Floridagrid.15276.37 Health Shands Hospital, Gainesville, Florida, USA., Ashton J; Pharmacy Department, University of Floridagrid.15276.37 Health Shands Hospital, Gainesville, Florida, USA., Venugopalan V; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Floridagrid.15276.37, Gainesville, Florida, USA., Droege ME; Department of Pharmacy Services, UC Health, University of Cincinnati Medical Centergrid.413561.4, Cincinnati, Ohio, USA.; Department of Pharmacy Practices & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA., Philpott CD; Department of Pharmacy Services, UC Health, University of Cincinnati Medical Centergrid.413561.4, Cincinnati, Ohio, USA.; Department of Pharmacy Practices & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA., Droege CA; Department of Pharmacy Services, UC Health, University of Cincinnati Medical Centergrid.413561.4, Cincinnati, Ohio, USA.; Department of Pharmacy Practices & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA., Healy DP; Department of Pharmacy Practices & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA., Mueller EW; Department of Pharmacy Services, UC Health, University of Cincinnati Medical Centergrid.413561.4, Cincinnati, Ohio, USA.; Department of Pharmacy Practices & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA., Peloquin CA; Infectious Disease Pharmacokinetics Laboratory, Emerging Pathogens Institute, University of Floridagrid.15276.37, Gainesville, Florida, USA.; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Floridagrid.15276.37, Gainesville, Florida, USA.
Jazyk: angličtina
Zdroj: Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2022 Jan 18; Vol. 66 (1), pp. e0161121. Date of Electronic Publication: 2021 Oct 18.
DOI: 10.1128/AAC.01611-21
Abstrakt: Patients admitted to the intensive care unit (ICU) may need continuous renal replacement therapy (CRRT) due to acute kidney injury or worsening of underlying chronic kidney disease. This will affect their antimicrobial exposure and may have a significant impact on the treatment. We aim to develop a cefepime pharmacokinetic (PK) model in CRRT ICU patients and generate the posterior predictions for a group and assess their therapy outcomes. Adult patients, who were admitted to the ICU, received cefepime, and had its concentration measured while on CRRT were included from three different data sets. In two data sets, samples were collected from the predialyzer, postdialyzer ports, and effluent fluid at different times within the same dosing interval. The third data set had only cefepime plasma concentration measured as part of clinical service. Patients' demographics, cefepime regimens and concentration, CRRT parameters, and therapy outcomes were recorded. NPAG was used for population PK and posterior predictions. A total of 125 patients were included. Cefepime was described by a five-compartment model, and the CRRT flow rates described the rates of cefepime transfer between compartments. The posterior predictions were generated for the third data set and the median (range) f T >MIC was 100% (27%-100%) and f T >4×MIC was 64% (0%-100%). The mortality rate was 53%. There was no difference in target attainment in terms of clinical cure and 30-day mortality. This model can be used as a precision dosing tool in CRRT patients. Future studies may address other PK/PD targets in a larger population.
Databáze: MEDLINE
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