کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5667029 | 1591743 | 2017 | 6 صفحه PDF | دانلود رایگان |
- Antibiotic dosing in continuous renal replacement therapy in ICU patients is highly challenging.
- Over one-third of patients had concentrations outside the therapeutic range.
- 24% of therapeutic drug monitoring (TDM) results manifested unnecessarily high antibiotic concentrations.
- TDM is useful for ensuring optimised dosing.
- Hospital-acquired pneumonia patients had the highest rates of excessive antibiotic concentrations.
The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10Ãâthe minimum inhibitory concentration (MIC). A total of 111 TDM samples from 76 patients (46 male) with a meanâ±âstandard deviation age of 56.6â±â15.9 years and weight of 89.1â±â25.8âkg were identified. The duration of antibiotic therapy was between 2 days and 42 days. TDM identified a need for dose modification of β-lactam antibiotics in 39 (35%) instances; in 27 (24%) samples, TDM values resulted in decreasing the prescribed dose of β-lactam antibiotic whereas an increase in the prescribed dose occurred in 12 (11%) cases. In patients treated for hospital-acquired pneumonia and primary or secondary bacteraemia, the dose was required to be decreased in 10/25 (40%) and 7/46 (15%) cases, respectively, to attain target concentrations. β-Lactam TDM is a useful tool for guiding drug dosing in complex patients such as those receiving CRRT. Although over one-third of patients manifested concentrations outside the therapeutic range, most of these CRRT patients had excessive β-lactam concentrations.
Journal: International Journal of Antimicrobial Agents - Volume 49, Issue 5, May 2017, Pages 589-594