Concentration of meropenem in patients with sepsis and acute kidney injury before and after initiation of continuous renal replacement therapy: a prospective observational trial

Autor: Ilona Nowak-Kózka, Anna Gielicz, Bartosz Kudliński, Wojciech Szczeklik, Kamil Polok, Bożena Seczyńska, Mirosław Czuczwar, Jacek Górka, Jakub Fronczek
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Continuous Renal Replacement Therapy
Critical Illness
therapeutic drug monitoring
medicine.medical_treatment
030106 microbiology
Meropenem
Citric Acid
Cohort Studies
sepsis
Sepsis
03 medical and health sciences
0302 clinical medicine
Pharmacokinetics
Tandem Mass Spectrometry
meropenem
Interquartile range
continuous venovenous hemodialysis
Blood plasma
Humans
Medicine
Prospective Studies
Renal replacement therapy
Chromatography
High Pressure Liquid
Aged
Pharmacology
medicine.diagnostic_test
business.industry
Acute kidney injury
Anticoagulants
030208 emergency & critical care medicine
General Medicine
Acute Kidney Injury
Middle Aged
medicine.disease
regional citrate anticoagulation
Anti-Bacterial Agents
Therapeutic drug monitoring
Anesthesia
Female
business
medicine.drug
Zdroj: Pharmacological Reports. 72:147-155
ISSN: 2299-5684
1734-1140
Popis: Background The effect of renal replacement therapy on drug concentrations in patients with sepsis has not been fully elucidated because the pharmacokinetic properties of many antimicrobials are influenced by both pathophysiological and treatment-related factors. The aim of this study was to determine meropenem concentrations in patients with sepsis before and after the initiation of continuous venovenous hemodialysis with regional citrate anticoagulation (RCA-CVVHD). Methods The study included 15 critically ill patients undergoing RCA-CVVHD due to sepsis-induced acute kidney injury. All participants received 2 g of meropenem every 8 h in a prolonged infusion lasting 3 h. Meropenem concentrations were measured in blood plasma using high-performance liquid chromatography coupled with tandem mass spectrometry. Blood samples were obtained at six-time points prior to and at six-time points after introducing RCA-CVVHD. Results The median APACHE IV and SOFA scores on admission were 118 points (interquartile range [IQR] 97–134 points) and 19.5 points (IQR 18–21 points), respectively. There were no significant differences in the plasma concentrations of meropenem measured directly before RCA-CVVHD and during the first 450 min of the procedure. The drug concentration reached its peak 2 h after initiating the infusion and then steadily declined. Conclusions The concentration of high-dose meropenem (2 g every 8 h) administered in a prolonged infusion was similar before and after the introduction of RCA-CVVHD in patients with sepsis who developed acute kidney injury.
Databáze: OpenAIRE
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