Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy

(1) Purpose of this study: To determine whether patient weight influences the probability of target attainment (PTA) over 72 h of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, ertapenem, meropenem) antibiotics in the critical care setting...

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Autores principales:	Soo-Min Jang, Alex R. Shaw, Bruce A. Mueller
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	renal replacement therapy Monte Carlo simulation antibiotics pharmacokinetics pharmacodynamics Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/5bcee60ef9e649d49575e404c352675b
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spelling	oai:doaj.org-article:5bcee60ef9e649d49575e404c352675b2021-11-25T16:24:32ZSize Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy10.3390/antibiotics101113902079-6382https://doaj.org/article/5bcee60ef9e649d49575e404c352675b2021-11-01T00:00:00Zhttps://www.mdpi.com/2079-6382/10/11/1390https://doaj.org/toc/2079-6382(1) Purpose of this study: To determine whether patient weight influences the probability of target attainment (PTA) over 72 h of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, ertapenem, meropenem) antibiotics in the critical care setting. This is the first paper to address the question of whether patient size affects antibiotic PTA in the ICU. (2) Methods: We performed a post hoc analysis of Monte Carlo simulations conducted in virtual critically ill patients receiving antibiotics and continuous renal replacement therapy. The PTA was calculated for each antibiotic on the following pharmacodynamic (PD) targets: (a) were above the target organism’s minimum inhibitory concentration (≥%fT≥1×MIC), (b) were above four times the MIC (≥%fT≥4×MIC), and (c) were always above the MIC (≥100%fT≥MIC) for the first 72 h of antibiotic therapy. The PTA was analyzed in patient weight quartiles [Q1 (lightest)-Q4 (heaviest)]. Optimal doses were defined as the lowest dose achieving ≥90% PTA. (3) Results: The PTA for fT≥1×MIC led to similarly high rates regardless of weight quartiles. Yet, patient weight influenced the PTA for higher PD targets (100%fT≥MIC and fT≥4×MIC) with commonly used beta-lactams and carbapenems. Reaching the optimal PTA was more difficult with a PD target of 100%fT≥MIC compared to fT≥4×MIC. (4) Conclusions: The Monte Carlo simulations showed patients in lower weight quartiles tended to achieve higher antibiotic pharmacodynamic target attainment compared to heavier patients.Soo-Min JangAlex R. ShawBruce A. MuellerMDPI AGarticlerenal replacement therapyMonte Carlo simulationantibioticspharmacokineticspharmacodynamicsTherapeutics. PharmacologyRM1-950ENAntibiotics, Vol 10, Iss 1390, p 1390 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	renal replacement therapy Monte Carlo simulation antibiotics pharmacokinetics pharmacodynamics Therapeutics. Pharmacology RM1-950
spellingShingle	renal replacement therapy Monte Carlo simulation antibiotics pharmacokinetics pharmacodynamics Therapeutics. Pharmacology RM1-950 Soo-Min Jang Alex R. Shaw Bruce A. Mueller Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
description	(1) Purpose of this study: To determine whether patient weight influences the probability of target attainment (PTA) over 72 h of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, ertapenem, meropenem) antibiotics in the critical care setting. This is the first paper to address the question of whether patient size affects antibiotic PTA in the ICU. (2) Methods: We performed a post hoc analysis of Monte Carlo simulations conducted in virtual critically ill patients receiving antibiotics and continuous renal replacement therapy. The PTA was calculated for each antibiotic on the following pharmacodynamic (PD) targets: (a) were above the target organism’s minimum inhibitory concentration (≥%fT≥1×MIC), (b) were above four times the MIC (≥%fT≥4×MIC), and (c) were always above the MIC (≥100%fT≥MIC) for the first 72 h of antibiotic therapy. The PTA was analyzed in patient weight quartiles [Q1 (lightest)-Q4 (heaviest)]. Optimal doses were defined as the lowest dose achieving ≥90% PTA. (3) Results: The PTA for fT≥1×MIC led to similarly high rates regardless of weight quartiles. Yet, patient weight influenced the PTA for higher PD targets (100%fT≥MIC and fT≥4×MIC) with commonly used beta-lactams and carbapenems. Reaching the optimal PTA was more difficult with a PD target of 100%fT≥MIC compared to fT≥4×MIC. (4) Conclusions: The Monte Carlo simulations showed patients in lower weight quartiles tended to achieve higher antibiotic pharmacodynamic target attainment compared to heavier patients.
format	article
author	Soo-Min Jang Alex R. Shaw Bruce A. Mueller
author_facet	Soo-Min Jang Alex R. Shaw Bruce A. Mueller
author_sort	Soo-Min Jang
title	Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
title_short	Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
title_full	Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
title_fullStr	Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
title_full_unstemmed	Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy
title_sort	size matters: the influence of patient size on antibiotics exposure profiles in critically ill patients on continuous renal replacement therapy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/5bcee60ef9e649d49575e404c352675b
work_keys_str_mv	AT soominjang sizematterstheinfluenceofpatientsizeonantibioticsexposureprofilesincriticallyillpatientsoncontinuousrenalreplacementtherapy AT alexrshaw sizematterstheinfluenceofpatientsizeonantibioticsexposureprofilesincriticallyillpatientsoncontinuousrenalreplacementtherapy AT bruceamueller sizematterstheinfluenceofpatientsizeonantibioticsexposureprofilesincriticallyillpatientsoncontinuousrenalreplacementtherapy
_version_	1718413201006133248

Size Matters: The Influence of Patient Size on Antibiotics Exposure Profiles in Critically Ill Patients on Continuous Renal Replacement Therapy

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