Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients

Background: The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Methods: Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacill...

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Autores principales:	Amandine Polain, Julie Gorham, Immacolata Romeo, Mirko Belliato, Lorenzo Peluso, Francesco Partipilo, Hassane Njimi, Alexandre Brasseur, Frederique Jacobs, Jacques Creteur, Maya Hites, Fabio Silvio Taccone
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	ECMO antibiotics therapeutic drug monitoring critical illness Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/4f2ef32e759b42aaa8fc534a1755e74d
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spelling	oai:doaj.org-article:4f2ef32e759b42aaa8fc534a1755e74d2021-11-25T18:24:20ZPrediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients10.3390/microorganisms91122192076-2607https://doaj.org/article/4f2ef32e759b42aaa8fc534a1755e74d2021-10-01T00:00:00Zhttps://www.mdpi.com/2076-2607/9/11/2219https://doaj.org/toc/2076-2607Background: The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Methods: Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (C<sub>min</sub>) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if C<sub>min</sub> was below the clinical breakpoint of Pseudomonas aeruginosa. Results: A total of 222 C<sub>min</sub> (CEF, n = 41; TZP, n = 85; MEM, n = 96) from 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient C<sub>min</sub> were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. Conclusions: Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction.Amandine PolainJulie GorhamImmacolata RomeoMirko BelliatoLorenzo PelusoFrancesco PartipiloHassane NjimiAlexandre BrasseurFrederique JacobsJacques CreteurMaya HitesFabio Silvio TacconeMDPI AGarticleECMOantibioticstherapeutic drug monitoringcritical illnessBiology (General)QH301-705.5ENMicroorganisms, Vol 9, Iss 2219, p 2219 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ECMO antibiotics therapeutic drug monitoring critical illness Biology (General) QH301-705.5
spellingShingle	ECMO antibiotics therapeutic drug monitoring critical illness Biology (General) QH301-705.5 Amandine Polain Julie Gorham Immacolata Romeo Mirko Belliato Lorenzo Peluso Francesco Partipilo Hassane Njimi Alexandre Brasseur Frederique Jacobs Jacques Creteur Maya Hites Fabio Silvio Taccone Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
description	Background: The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Methods: Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (C<sub>min</sub>) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if C<sub>min</sub> was below the clinical breakpoint of Pseudomonas aeruginosa. Results: A total of 222 C<sub>min</sub> (CEF, n = 41; TZP, n = 85; MEM, n = 96) from 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient C<sub>min</sub> were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. Conclusions: Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction.
format	article
author	Amandine Polain Julie Gorham Immacolata Romeo Mirko Belliato Lorenzo Peluso Francesco Partipilo Hassane Njimi Alexandre Brasseur Frederique Jacobs Jacques Creteur Maya Hites Fabio Silvio Taccone
author_facet	Amandine Polain Julie Gorham Immacolata Romeo Mirko Belliato Lorenzo Peluso Francesco Partipilo Hassane Njimi Alexandre Brasseur Frederique Jacobs Jacques Creteur Maya Hites Fabio Silvio Taccone
author_sort	Amandine Polain
title	Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
title_short	Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
title_full	Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
title_fullStr	Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
title_full_unstemmed	Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients
title_sort	prediction of insufficient beta-lactam concentrations in extracorporeal membranous oxygenation patients
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/4f2ef32e759b42aaa8fc534a1755e74d
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Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients

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