scholarly journals 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

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Dennis Kühn ◽  
Carlos Metz ◽  
Frederik Seiler ◽  
Holger Wehrfritz ◽  
Sophie Roth ◽  
...  
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Serum Concentrations ◽  
Icu Patients ◽  
Intensive Care Patients

Abstract 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 < 0.001), required renal replacement therapy more frequently (53.3% vs. 32.0%; p = 0.048) and had an elevated ICU mortality (60.0% vs. 22.7%; p < 0.001). Data on antibiotic serum concentrations derived from 112 measurements among ECMO and 186 measurements from non-ECMO patients showed significantly lower median serum concentrations for piperacillin (32.3 vs. 52.9; p = 0.029) and standard-dose meropenem (15.0 vs. 17.8; p = 0.020) in the ECMO group. We found high rates of insufficient antibiotic serum concentrations below the pre-specified MIC target among ECMO patients (piperacillin: 48% vs. 13% in non-ECMO; linezolid: 35% vs. 15% in non-ECMO), whereas no such difference was observed for ceftazidime and meropenem. 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.

scholarly journals A Comparison between Endostatin and Conventional Biomarkers on 30-Day Mortality and Renal Replacement Therapy in Unselected Intensive Care Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1603
Author(s):  
Toralph Ruge ◽  
Anders Larsson ◽  
Miklós Lipcsey ◽  
Jonas Tydén ◽  
Joakim Johansson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Icu Patients ◽  
Intensive Care Patients ◽  
General Populations ◽  
Kidney Impairment ◽  
Predicted Risk

Endostatin may predict mortality and kidney impairment in general populations as well as in critically ill patients. We decided to explore the possible role of endostatin as a predictor of 30-day mortality, acute kidney injury (AKI), and renal replacement therapy (RRT) in a cohort of unselected intensive care unit (ICU) patients. Endostatin and creatinine in plasma were analyzed and SAPS3 was determined in 278 patients on ICU arrival at admission to a Swedish medium-sized hospital. SAPS3 had the highest predictive value, 0.85 (95% C.I.: 0.8–0.90), for 30-day mortality. Endostatin, in combination with age, predicted 30-day mortality by 0.76 (95% C.I.: 0.70–0.82). Endostatin, together with age and creatinine, predicted AKI with 0.87 (95% C.I.: 0.83–0.91). Endostatin predicted AKI with [0.68 (0.62–0.74)]. Endostatin predicted RRT, either alone [0.82 (95% C.I.: 0.72–0.91)] or together with age [0.81 (95% C.I.: 0.71–0.91)]. The predicted risk for 30-day mortality, AKI, or RRT during the ICU stay, predicted by plasma endostatin, was not influenced by age. Compared to the complex severity score SAPS3, circulating endostatin, combined with age, offers an easily managed option to predict 30-day mortality. Additionally, circulating endostatin combined with creatinine was closely associated with AKI development.

Therapeutic drug monitoring of vancomycin in a patient on extracorporeal membrane oxygenation therapy in intensive care unit

2018 ◽  
Vol 74 (8) ◽  
pp. 1093-1094 ◽  
Author(s):  
L. Herrera Hidalgo ◽  
A. B. Guisado Gil ◽  
M. V. Gil Navarro ◽  
L. Martín Villén ◽  
Y. Corcia Palomo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

Therapeutic Drug Monitoring in Neonatal HSV Infection on Continuous Renal Replacement Therapy

PEDIATRICS ◽  
2015 ◽  
Vol 136 (1) ◽  
pp. e270-e274 ◽  
Author(s):  
T. Funaki ◽  
I. Miyata ◽  
K. Shoji ◽  
Y. Enomoto ◽  
S. Sakamoto ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Therapeutic Drug Monitoring ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Drug Monitoring ◽  
Therapeutic Drug

scholarly journals Cefiderocol in Critically Ill Patients with Multi-Drug Resistant Pathogens: Real-Life Data on Pharmacokinetics and Microbiological Surveillance

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 649
Author(s):  
Christina König ◽  
Anna Both ◽  
Holger Rohde ◽  
Stefan Kluge ◽  
Otto R. Frey ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Therapeutic Drug Monitoring ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Therapeutic Drug ◽  
Renal Elimination ◽  
Drug Resistant

Cefiderocol is a new siderophore-cephalosporin for the treatment of multi-drug resistant Gram-negative pathogens. As a reserve agent, it will and should be used primarily in critically ill patients in the upcoming years. Due to the novelty of the substance little data on the pharmacokinetics in critically ill patients with septic shock and renal failure (including continuous renal replacement therapy and cytokine adsorber therapy) is available. We performed therapeutic drug monitoring in a cohort of five patients treated with cefiderocol, to improve the knowledge on pharmacokinetics in this vulnerable patient population. As expected for a cephalosporin with predominantly renal elimination the maintenance dose could be reduced in patients with renal impairment or on continuous renal replacement therapy. The manufacturer’s dosing instructions were sufficient to achieve a drug level well above the MIC. However, the addition of a cytokine adsorber might reduce serum levels substantially, so that in this context therapeutic drug monitoring and dose adjustment are recommended.

scholarly journals Therapeutic Drug Monitoring of Continuous Infusion Doripenem in a Pediatric Patient on Continuous Renal Replacement Therapy

2017 ◽  
Vol 22 (1) ◽  
pp. 69-73
Author(s):  
Jeffrey J. Cies ◽  
Wayne S. Moore ◽  
Susan B. Conley ◽  
Paul Shea ◽  
Adela Enache ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Therapeutic Drug Monitoring ◽  
Continuous Renal Replacement Therapy ◽  
Continuous Infusion ◽  
Replacement Therapy ◽  
Drug Monitoring ◽  
Severe Combined Immunodeficiency ◽  
Elevated Serum ◽  
Therapeutic Drug ◽  
Pharmacokinetic Data

An 11-year-old African American male with severe combined immunodeficiency variant, non-cystic fibrosis bronchiectasis, pancreatic insufficiency, chronic mycobacterium avium-intracellulare infection, chronic sinusitis, and malnutrition presented with a 1-week history of fevers. He subsequently developed respiratory decompensation and cefepime was discontinued and doripenem was initiated. Doripenem was the carbapenem used due to a national shortage of meropenem. By day 7 the patient (24.7 kg) had a positive fluid balance of 6925 mL (28% FO), and on days 7 into 8 developed acute kidney injury evidenced by an elevated serum creatinine of 0.68 mg/dL, an increase from the baseline of 0.28 mg/dL. On day 9, the patient was initiated on continuous renal replacement therapy (CRRT) and the doripenem dosing was changed to a continuous infusion of 2.5 mg/kg/hr (60 mg/kg/day). Approximately 12.5 hours after the start of the doripenem a serum concentration was obtained, which was 4.01 mg/L corresponding to a clearance of 10.5 mL/min/kg. The pediatric dosing and pharmacokinetic data available for doripenem suggest a clearance estimate of 4.4 to 4.8 mL/min/kg, and the adult clearance estimate is 2.4 to 3.78 mL/min/kg. The calculated clearance in our patient of 10.5 mL/min/kg is over double the highest clearance estimate in the pediatric literature. This case demonstrates that doripenem clearance is significantly increased with CRRT in comparison with the published pediatric and adult data. An appropriate pharmacodynamic outcome (time that free drug concentration &gt; minimum inhibitory concentration) can be achieved by continuous infusion doripenem with concurrent therapeutic drug monitoring.

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