Evaluation of pharmacokinetic and pharmacodynamic parameters of meropenem in critically ill patients with acute kidney disease.

PURPOSE: No study has been evaluated pharmacokinetic (PK) and pharmacodynamic (PD) properties of ß-lactam antibiotics in patients with acute kidney injury (AKI), not requiring renal replacement therapy (RRT). We evaluated the time that plasma concentrations remain above four times the MIC (ft > 4MIC) and PK parameters of meropenem in this population. METHODS: In this prospective, randomized clinical trial (RCT), all patients received standard dose (3 g daily) of meropenem for 48 h, then randomly allocated in standard or adjusted groups. The standard group received meropenem without dose adjustment. In the adjusted group, the meropenem dose was adjusted based on the Cockcroft-Gault(C-G) equation. Meropenem concentrations were measured at the peak and trough times on the 2nd and 5th days of the study. RESULTS: On the 2nd day of the study, 3 out of 10 (30%) of patients attained the PD target (≥ 80%ft > 4MIC). In the 5th day of the study, the PD target was attained in 2 out of 10 (20%) and 1 out of 5 (20%) of patients who received standard and adjusted doses of meropenem, respectively (p = 1). In all samples, increased volume of distribution (Vd) (median; IQR) (46.04; 23.06-103.18 L), terminal half-life (T1/2) (4.51; 2.67-8.88 h) and decreased clearance (6.52; 4.43-10.16 L/h) have been shown. CONCLUSION: In critically ill patients with AKI, who not receive RRT, standard doses, and adjusted according to renal function of meropenem failed to achieve PD target of ≥ 80%ft > 4MIC. Higher doses are required for this target. RETROSPECTIVELY REGISTERED: The study protocol with registered retrospectively and approved on January 19, 2019, with the number of IRCT20160412027346N5.

Comparison Between Vancomycin Lock and Taurolock Solution for the Prevention of Catheter- related Infections in Hemodialysis Patients, A Multicenter Study.

INTRODUCTION: Central venous catheters, frequently used in patients undergoing hemodialysis, place the patients at high risk of catheter-related infections. Therefore, it is essential to select the optimal prevention protocol for these infections. This study aims to compare the efficacy of the Taurolock solution and antibiotic lock in preventing tunneled catheter (permcath) related infections. METHODS: This multicenter study was conducted between June 2020 and July 2021 on 86 hemodialysis patients with a central venous catheter from four dialysis centers in Tehran, Iran. The patients were randomly assigned into two groups. The first group received Taurolock, and the second group received antibiotic lock (a combination of vancomycin and heparin) at the end of each dialysis session. Peripheral blood and catheter blood samples were collected once before the intervention and monthly thereafter, for up to six months, and blood culture performed for detection of various bacterial strains. RESULTS: The findings showed no significant difference in the infection rate (positive peripheral blood or catheter cultures) between the Taurolock and vancomycin groups (P > .05). Additionally, there was no significant difference in the duration of catheter implantation in individuals with positive and negative cultures (P > .05). Furthermore, no significant correlation was found between comorbidities and catheter-related infection in patients of the two groups (P > .05). CONCLUSION: There was no significant difference between the two groups in the rate of catheter-related infection. Therefore, vancomycin lock solutions can be good alternatives to Taurolock solution for preventing catheter-related infections.  DOI: 10.52547/ijkd.7615.

Acute Kidney Injury Outcome in COVID-19 Patients.

INTRODUCTION: Despite the high incidence of AKI in patients with COVID-19, the characteristics and consequences of this condition have not been well studied. METHODS: This retrospective cohort study investigated the clinical characteristics, treatment methods, and outcome of COVID-19 patients aged 18 years and older who were hospitalized in Imam Hossein Hospital, Tehran, from February 20th, 2020 to June 20th, 2020. RESULTS: Out of the total 367 patients with COVID-19, 104 (28%) patients were diagnosed with AKI at the time of admission or during hospitalization, 86 (23%) and 18 (5%) patients were diagnosed with the AKI on admission (early AKI) and after the first 24 h (late AKI), respectively. Concerning the AKI stages, 20 (19%) and 18 (17%) patients were in stages 2 and 3, and the cause of AKI in 52 (50%) patients was renal. Moreover, out of all patients with AKI, 25 (24%) and 29 (28%) patients had transient (Kidney function improvement within 48 h) and persistent AKI (kidney function improvement between 48 h to 7 days). Furthermore, 32 (31%) patients developed acute kidney damage (AKD) (no improvement in AKI after 7 days). The survival rate of AKI patients was lower in higher stages of AKI, and in cases that the reason for kidney dysfunction was renal or unknown. However, there was no difference in the mortality rate between the early and late AKI. CONCLUSION: Since about one-third of the patients with AKI eventually develop AKD, it is of great importance to closely monitor all COVID-19 patients, especially the high-risk ones, for the appropriate diagnosis and treatment of AKI.  DOI: 10.52547/ijkd.6610.