Antibiotic therapeutic drug monitoring in intensive care patients treated with different modalities of extracorporeal membrane oxygenation (ECMO) and renal replacement therapy: a prospective, observational single-center study
| Autor: | Sophie Roth, Frederik Seiler, Mathias Hoffmann, Sören L. Becker, Jürgen Geisel, Carlos Metz, André Becker, Stefan Wagenpfeil, Mohammad Alqudrah, Hendrik Bracht, Holger Wehrfritz, Ulrich Hübner, Dennis Kühn, Philipp M. Lepper, Robert Bals |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_treatment Bacteremia Therapeutic drug monitoring Critical Care and Intensive Care Medicine Meropenem Tazobactam Ceftazidime 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation Antibiotics Intensive care Germany Sepsis Diagnosis medicine Extracorporeal membrane oxygenation Humans 030212 general & internal medicine Renal replacement therapy Prospective Studies Aged Multiresistant bacteria medicine.diagnostic_test business.industry Research Linezolid 030208 emergency & critical care medicine Middle Aged medicine.disease Anti-Bacterial Agents Renal Replacement Therapy Intensive Care Units surgical procedures operative Piperacillin Tazobactam Drug Combination Anesthesia Female Drug Monitoring business Infection medicine.drug Piperacillin |
| Zdroj: | Critical Care |
| DOI: | 10.22028/d291-33612 |
| Popis: | Background Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for the treatment of respiratory and/or cardiac failure. However, it remains unclear whether dose adjustments are necessary to avoid subtherapeutic drug levels in septic patients on ECMO support. Here, we aimed to evaluate and comparatively assess serum concentrations of continuously applied antibiotics in intensive care patients being treated with and without ECMO. Methods Between October 2018 and December 2019, we prospectively enrolled patients on a pneumological ICU in southwest Germany who received antibiotic treatment with piperacillin/tazobactam, ceftazidime, meropenem, or linezolid. All antibiotics were applied using continuous infusion, and therapeutic drug monitoring of serum concentrations (expressed as mg/L) was carried out using high-performance liquid chromatography. Target concentrations were defined as fourfold above the minimal inhibitory concentration (MIC) of susceptible bacterial isolates, according to EUCAST breakpoints. Results The final cohort comprised 105 ICU patients, of whom 30 were treated with ECMO. ECMO patients were significantly younger (mean age: 47.7 vs. 61.2 years; p Conclusions ECMO treatment was associated with significantly reduced serum concentrations of specific antibiotics. Future studies are needed to assess the pharmacokinetic characteristics of antibiotics in ICU patients on ECMO support. |
| Databáze: | OpenAIRE |
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