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 |
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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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