Higher than standard dosing regimen are needed to achieve optimal antibiotic exposure in critically ill patients with augmented renal clearance receiving piperacillin-tazobactam administered by continuous infusion.
J Crit Care
; 48: 66-71, 2018 12.
Article
en En
| MEDLINE
| ID: mdl-30172963
ABSTRACT
PURPOSE:
To determine whether augmented renal clearance (ARC) impacts negatively on piperacillin-tazobactam unbound concentrations in critically ill patients receiving 16â¯g/2â¯g/day administered continuously. MATERIAL ANDMETHODS:
Fifty nine critically ill patients without renal impairment underwent 24-h creatinine clearance (CrCL) measurement and therapeutic drug monitoring during the first three days of antimicrobial therapy by piperacillin-tazobactam. The main outcome was the rate of piperacillin underexposure, defined by at least one of three samples under 16â¯mg/L. Monte Carlo simulation was performed to predict the distribution of piperacillin concentrations for various CrCL and minimal inhibitory concentration (MIC) values.RESULTS:
The rate of piperacillin underexposure was 19%, significantly higher in ARC patients (0 vs. 31%, pâ¯=â¯.003). A threshold of CrCLâ¯≥â¯170â¯mL/min had a sensitivity and specificity of 1 (95%CI 0.79-1) and 0.69 (95%CI 0.61-0.76) to predict piperacillin underexposure. In ARC patients, a 20â¯g/2.5â¯g/24â¯h PTZ dosing regimen was associated with the highest probability to reach the 16â¯mg/L empirical target, without risk of excessive dosing.CONCLUSIONS:
When targeting a theoretical MIC at the upper limit of the susceptibility range, the desirable target (100%fT>16) may not be achieved in patients with CrCLâ¯≥â¯170â¯mL/min receiving PTZ 16â¯g/2â¯g/day administered continuously.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Sepsis
/
Combinación Piperacilina y Tazobactam
/
Antibacterianos
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Crit Care
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2018
Tipo del documento:
Article