Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion

Effective antibiotic therapy of cerebral infections such as meningitis or ventriculitis is hindered by low penetration into the cerebrospinal fluid (CSF). Because continuous infusion of meropenem and vancomycin and routine therapeutic drug monitoring (TDM) have been proposed to optimize antimicrobia...

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Autores principales:	Christoph Tiede, Ute Chiriac, Daniel Dubinski, Florian J. Raimann, Otto R. Frey, Anka C. Röhr, Anna Wieduwilt, Michael Eibach, Natalie Filmann, Christian Senft, Kai Zacharowski, Volker Seifert, Jan Mersmann
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	meropenem vancomycin therapeutic drug monitoring ventriculitis pharmacokinetics critical care Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/73c1a0fba63e4d55a69f5689187453a4
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spelling	oai:doaj.org-article:73c1a0fba63e4d55a69f5689187453a42021-11-25T16:25:10ZCerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion10.3390/antibiotics101114212079-6382https://doaj.org/article/73c1a0fba63e4d55a69f5689187453a42021-11-01T00:00:00Zhttps://www.mdpi.com/2079-6382/10/11/1421https://doaj.org/toc/2079-6382Effective antibiotic therapy of cerebral infections such as meningitis or ventriculitis is hindered by low penetration into the cerebrospinal fluid (CSF). Because continuous infusion of meropenem and vancomycin and routine therapeutic drug monitoring (TDM) have been proposed to optimize antimicrobial exposure in ventriculitis patients, an individualized dosing strategy was implemented in our department. We present a retrospective analysis of meropenem and vancomycin concentrations in serum and CSF in the first nine ventriculitis patients treated with continuous infusion and TDM-guided dose optimization aiming at 20–30 mg/L. Median initial dosing was 8.8 g/24 h meropenem and 4.25 g/24 h vancomycin, respectively, resulting in median serum concentrations of 21.3 mg/L for meropenem and 24.5 mg/L for vancomycin and CSF concentrations of 3.4 mg/L for meropenem and 1.7 mg/L for vancomycin. Median CSF penetration was 15% for meropenem and 7% for vancomycin. With initial dosing, all but one patient achieved CSF concentrations above 1 mg/L. Dose adjustment according to TDM ensured sufficient CSF concentrations in all patients within 48 h of treatment. Given the limited penetration, continuous infusion of meropenem and vancomycin based on renal function and TDM-guided dose optimization appears a reasonable approach to attain sufficient CSF concentrations in ventriculitis patients.Christoph TiedeUte ChiriacDaniel DubinskiFlorian J. RaimannOtto R. FreyAnka C. RöhrAnna WieduwiltMichael EibachNatalie FilmannChristian SenftKai ZacharowskiVolker SeifertJan MersmannMDPI AGarticlemeropenemvancomycintherapeutic drug monitoringventriculitispharmacokineticscritical careTherapeutics. PharmacologyRM1-950ENAntibiotics, Vol 10, Iss 1421, p 1421 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	meropenem vancomycin therapeutic drug monitoring ventriculitis pharmacokinetics critical care Therapeutics. Pharmacology RM1-950
spellingShingle	meropenem vancomycin therapeutic drug monitoring ventriculitis pharmacokinetics critical care Therapeutics. Pharmacology RM1-950 Christoph Tiede Ute Chiriac Daniel Dubinski Florian J. Raimann Otto R. Frey Anka C. Röhr Anna Wieduwilt Michael Eibach Natalie Filmann Christian Senft Kai Zacharowski Volker Seifert Jan Mersmann Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
description	Effective antibiotic therapy of cerebral infections such as meningitis or ventriculitis is hindered by low penetration into the cerebrospinal fluid (CSF). Because continuous infusion of meropenem and vancomycin and routine therapeutic drug monitoring (TDM) have been proposed to optimize antimicrobial exposure in ventriculitis patients, an individualized dosing strategy was implemented in our department. We present a retrospective analysis of meropenem and vancomycin concentrations in serum and CSF in the first nine ventriculitis patients treated with continuous infusion and TDM-guided dose optimization aiming at 20–30 mg/L. Median initial dosing was 8.8 g/24 h meropenem and 4.25 g/24 h vancomycin, respectively, resulting in median serum concentrations of 21.3 mg/L for meropenem and 24.5 mg/L for vancomycin and CSF concentrations of 3.4 mg/L for meropenem and 1.7 mg/L for vancomycin. Median CSF penetration was 15% for meropenem and 7% for vancomycin. With initial dosing, all but one patient achieved CSF concentrations above 1 mg/L. Dose adjustment according to TDM ensured sufficient CSF concentrations in all patients within 48 h of treatment. Given the limited penetration, continuous infusion of meropenem and vancomycin based on renal function and TDM-guided dose optimization appears a reasonable approach to attain sufficient CSF concentrations in ventriculitis patients.
format	article
author	Christoph Tiede Ute Chiriac Daniel Dubinski Florian J. Raimann Otto R. Frey Anka C. Röhr Anna Wieduwilt Michael Eibach Natalie Filmann Christian Senft Kai Zacharowski Volker Seifert Jan Mersmann
author_facet	Christoph Tiede Ute Chiriac Daniel Dubinski Florian J. Raimann Otto R. Frey Anka C. Röhr Anna Wieduwilt Michael Eibach Natalie Filmann Christian Senft Kai Zacharowski Volker Seifert Jan Mersmann
author_sort	Christoph Tiede
title	Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
title_short	Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
title_full	Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
title_fullStr	Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
title_full_unstemmed	Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion
title_sort	cerebrospinal fluid concentrations of meropenem and vancomycin in ventriculitis patients obtained by tdm-guided continuous infusion
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/73c1a0fba63e4d55a69f5689187453a4
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Cerebrospinal Fluid Concentrations of Meropenem and Vancomycin in Ventriculitis Patients Obtained by TDM-Guided Continuous Infusion

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