Prolonged Infusion of Beta-lactam Antibiotics in Critically Ill Patients: Revisiting the Evidence

2018 ◽  
pp. 53-69
Author(s):  
S. A. M. Dhaese ◽  
V. Stove ◽  
J. J. De Waele
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Beta Lactam ◽  
Prolonged Infusion ◽  
Beta Lactam Antibiotics

scholarly journals Continuous Infusion Compared with Intermittent Intravenous Infusion of Beta-Lactam Antibiotics for Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Trials

2020 ◽  
Author(s):  
Chien-Huei Huang ◽  
Ching-Yao Shih ◽  
Meng Keng Tsay ◽  
Shen-Pei Hsuan ◽  
Yung-Hsin Tseng ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Eradication Rate ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Bacterial Eradication ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Beta Lactam Antibiotics

Abstract Background: The pathophysiologic changes during critical illness and high minimal inhibitory concentration (MIC) pathogens are important risk factors of mortality and bacterial eradication in critical care. Beta-lactam antibiotics have a time-dependent effect on bactericidal activity. The continuous infusion (CIF) of beta-lactam antibiotics achieves sufficient drug concentration above the MIC, especially for critically ill patients. However, the superiority of CIF over intermittent infusion (IIF) of beta-lactam antibiotics is yet to be clearly established. Thus, we aimed to investigate the effects on mortality of CIF of beta-lactams antibiotics in comparison to those of IIF of beta-lactams antibiotics in patients with sepsis admitted to the intensive care unit (ICU).Methods: We systematically searched PUBMED, MEDLINE, Cochrane Library, EMBASE, Web of Science, and ICTRP for randomized controlled trials (RCTs) comparing CIF with IIF of beta-lactam antibiotics in critically ill populations. All RCTs published until October 2019 were eligible. The primary outcome measure was the relative risk (RR) of mortality, while the secondary outcome measures were bacterial eradication rate, length of ICU stay, and length of admission. Results: In total, 6 RCTs comprising 974 patients were analyzed. We found a significantly lower mortality for critically ill patients on CIF (RR: 0.79; 95% CI: 0.63, 0.98) compared with those on IIF of beta-lactam antibiotics. The pooled RR for the bacterial eradication rate was 1.16 (95% CI: 1.03, 1.29) for CIF compared with IIF administration. Conclusion: CIF of beta-lactam antibiotics for critically ill patients significantly reduces mortality and yields a better bacterial eradication rate than IIF. These findings support the clinical and bacterial eradication benefits in adult critically ill patients, and may guide clinical discussions and decisions.

scholarly journals Conceptual model of adding antibiotics to dialysate fluid during renal replacement therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ieva Bartuseviciene ◽  
Vaidas Vicka ◽  
Alvita Vickiene ◽  
Lidija Tetianec ◽  
Marius Dagys ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Compartment Model ◽  
Beta Lactam ◽  
Antibiotic Concentration ◽  
Experimental Conditions ◽  
Beta Lactam Antibiotics ◽  
Dialysate Solution

AbstractStudies have shown significant variability in antibiotic trough concentrations in critically ill patients receiving renal replacement therapy (RRT). The purpose of this study was to assess whether adding beta-lactam antibiotics to dialysate solution can maintain stable antibiotic concentrations during RRT in experimental conditions. A single compartment model reflecting the patient was constructed and connected to the RRT machine. Dialysate fluid was prepared in three different concentrations of meropenem (0 mg/L; 16 mg/L; 64 mg/L). For each dialysate concentration various combinations of dialysate and blood flow rates were tested by taking different samples. Meropenem concentration in all samples was calculated using spectrophotometry method. Constructed experimental model results suggest that decrease in blood meropenem concentration can be up to 35.6%. Moreover, experimental data showed that antibiotic loss during RRT can be minimized and stable plasma antibiotic concentration can be achieved with the use of a 16 mg/L Meropenem dialysate solution. Furthermore, increasing meropenem concentration up to 64 mg/L is associated with an increase antibiotic concentration up to 18.7–78.8%. Administration of antibiotics to dialysate solutions may be an effective method of ensuring a constant concentration of antibiotics in the blood of critically ill patients receiving RRT.

scholarly journals Covariate determinants of effective dosing regimens for time-dependent beta-lactam antibiotics for critically ill patients

2018 ◽  
Vol 162 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Milan Kaska ◽  
Eduard Havel ◽  
Iva Selke-Krulichova ◽  
Petr Safranek ◽  
Jan Bezouska ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Dependent ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Dosing Regimens

Evaluation of studies on extended versus standard infusion of beta-lactam antibiotics

2019 ◽  
Vol 76 (18) ◽  
pp. 1383-1394 ◽  
Author(s):  
Melanie Chen ◽  
Valerie Buurma ◽  
Monica Shah ◽  
Germin Fahim
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Success ◽  
Beta Lactam ◽  
Therapeutic Success ◽  
Gram Negative ◽  
Beta Lactam Antibiotics ◽  
Drug Concentrations

AbstractPurposeTo summarize the current literature on the use and clinical efficacy of extended-infusion (EI) beta-lactam antibiotics, including piperacillin–tazobactam, meropenem, and cefepime.SummaryGram-negative infections are a serious concern among hospitalized patients and require innovative pharmacokinetic dosing strategies to achieve clinical success, especially as the emergence of resistant gram-negative pathogens has outpaced the development of new antibiotics. Beta-lactam antibiotics exhibit time-dependent activity, which means that optimal efficacy is achieved when free drug concentrations stay above the minimum inhibitory concentration for an extended duration of the recommended dosage interval. EI piperacillin–tazobactam therapy has demonstrated improved clinical outcomes and decrease mortality in critically ill patients with gram-negative infections, particularly Pseudomonas aeruginosa infections. EI meropenem has shown higher therapeutic success rates for patients with febrile neutropenia and shorter intensive care unit (ICU) length of stay (LOS) with a reduction in ventilator days in patients with multidrug-resistant ventilator-associated pneumonia. However, a larger study showed no difference in clinical outcomes between standard-infusion and EI meropenem. EI cefepime has been associated with decreased mortality and shorter ICU LOS in patients with Pseudomonas aeruginosa infections. Common challenges associated with EI beta-lactam antibiotics include Y-site incompatibilities, lack of intravenous access, and tubing residuals. It is important to note that factors such as diverse patient populations and study methodology, along with various antibiotic dose regimens, may have contributed to conflicting data on EI beta-lactam therapy.ConclusionBased on most published literature, there appears to be a favorable trend toward use of EI beta-lactam therapy in clinical practice, particularly in critically ill patients with gram-negative infections.

scholarly journals Health Care Costs of Target Attainment for Beta-Lactam Antibiotics in Critically Ill Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tim M.J. Ewoldt ◽  
Alan Abdulla ◽  
Nicole G.M. Hunfeld ◽  
Anouk E. Muller ◽  
Diederik Gommers ◽  
...  
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Health Care Costs ◽  
Critically Ill Patients ◽  
Beta Lactam ◽  
Target Attainment ◽  
Beta Lactam Antibiotics ◽  
Care Costs
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