Relationship of imipenem therapeutic drug monitoring to clinical outcomes in critically ill patients: a retrospective cohort study.

Autor: Wu Y; Department of Pharmacy, Nanjing Drum Tower Hospital, Traditional Chinese and Western Medicine Clinical College, Nanjing University of Chinese Medicine, Nanjing, China., Lu Z; Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China., Liang P; Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China., Zhu H; Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China., Qi H; Department of Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China., Zhang H; Department of Pharmacy, Nanjing Drum Tower Hospital, Traditional Chinese and Western Medicine Clinical College, Nanjing University of Chinese Medicine, Nanjing, China. zhx_510@hotmail.com.; Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China. zhx_510@hotmail.com.; Nanjing Medical Center for Clinical Pharmacy, Nanjing, China. zhx_510@hotmail.com.
Jazyk: angličtina
Zdroj: Naunyn-Schmiedeberg's archives of pharmacology [Naunyn Schmiedebergs Arch Pharmacol] 2024 Jul; Vol. 397 (7), pp. 4791-4798. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1007/s00210-023-02909-4
Abstrakt: The primary objective of this study was to evaluate the predictors associated with target concentration (non-)attainment of imipenem in critically ill patients. The secondary objective was to explore the correlation between achieving imipenem target concentrations and clinical outcomes of therapy. A retrospective cohort study was conducted in critically ill patients treated with imipenem. Clinical data were extracted from the patients' electronic medical records. The pharmacokinetic/pharmacodynamic target was defined as free imipenem concentrations above the minimum inhibitory concentration (MIC) of the pathogen at 100% (100%fT>MIC) of the dosing interval. Factors associated with the non-attainment of target concentrations were evaluated using binomial logistic regression. Kaplan-Meier analysis was used to investigate the correlation between (non-)attainment targets and 30-day mortality. A total of 406 patients were included, and 55.4% achieved the target of 100%fT>MIC. Regression analysis identified an initial daily dose of imipenem ≤ 2 g/day, augmented renal clearance, age ≤ 60 years, recent surgery, and absence of positive microbiology culture as risk factors for target non-attainment. Achieving the 100%fT>MIC target was significantly associated with clinical efficacy but not with 30-day mortality. Selective application of therapeutic drug monitoring in the early stages of imipenem treatment for critically ill patients can improve clinical outcomes. Further research should explore the potential benefits of TDM-guided dosing strategies for imipenem in critical care settings.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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