کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5666982 | 1591746 | 2017 | 4 صفحه PDF | دانلود رایگان |
- PK/PD optimisation of meropenem can overcome resistance of MDR Gram-negative organisms.
- Real-time clinical pharmacological advice is valuable in managing MDR infections.
- TDM-guided meropenem dosing may help in treating KPC-Kp with an MIC â¤64âmg/L.
The effect of real-time pharmacokinetic/pharmacodynamic (PK/PD) optimisation of high-dose continuous-infusion meropenem on the clinical outcome of patients receiving combination antimicrobial therapy for treatment of KPC-producing Klebsiella pneumoniae (KPC-Kp) infections was retrospectively assessed. Data for all patients with KPC-Kp-related infections who received antimicrobial combination therapy containing high-dose continuous-infusion meropenem optimised by means of therapeutic drug monitoring (TDM) were retrieved. Optimal PK/PD exposure was considered a steady-state concentration to minimum inhibitory concentration ratio (Css/MIC) of 1-4. Univariate binary logistic regression analysis was performed to identify independent predictors of clinical outcome. Among the 30 eligible patients, 53.3% had infections caused by meropenem-resistant KPC-Kp (MICââ¥â16âmg/L). Tigecycline and colistin were the two antimicrobials most frequently combined with meropenem. Mean doses of continuous-infusion meropenem ranged from 1.7 to 13.2âg/daily. The Css/MIC ratio was â¥1 in 73.3% of cases and â¥4 in 50.0%. Clinical outcome was successful in 73.3% of cases after a median treatment length of 14.0 days. In univariate analysis, a significant correlation with successful clinical outcome was found for a Css/MIC ratio â¥1 (ORâ=â10.556, 95% CI 1.612-69.122; Pâ=â0.014), a Css/MIC ratio â¥4 (ORâ=â12.250, 95% CI 1.268-118.361; Pâ=â0.030) and a Charlson co-morbidity index of â¥4 (ORâ=â0.158, 95% CI 0.025-0.999; Pâ=â0.05). High-dose continuous-infusion meropenem optimised by means of real-time TDM may represent a valuable tool in improving clinical outcome when dealing with the treatment of infections caused by KPC-Kp with a meropenem MICââ¤â64âmg/L.
Journal: International Journal of Antimicrobial Agents - Volume 49, Issue 2, February 2017, Pages 255-258