Association between antibiotic trough concentrations and estimated total renal clearance in critically ill patients receiving renal replacement therapy: A pragmatic, multi-national observational study
Refereed conference paper presented and published in conference proceedings


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摘要Background. Achieving appropriate blood antibiotic concentrations is important to optimise the treatment of sepsis and improve mortality.
Objective. To test the hypothesis that estimated total renal clearance (eTRCL) is inversely associated with trough concentrations achieved in ICU patients receiving continuous renal replacement therapy (CRRT).
Method. Prospective, observational, multi-national, pharmacokinetic study in 26 ICUs. Antibiotic dosing and CRRT prescription were determined by individual unit practice. Patient demographic, CRRT dose, antibiotic dose, clinical data and trough concentrations of meropenem, piperacillin-tazobactam, and vancomycin were evaluated. eTRCL was defined as CRRT clearance (effluent flow rate) plus measured creatinine clearance in patients with urine output.
Results. A total of 384 patients were enrolled from 26 ICUs. Patients received meropenem (n=187), piperacillin (n=160), tazobactam (n=101) and vancomycin (n=60). Generalised estimating equations were used to account for centre-effects. Despite wide variations in antibiotic dose (4 - 8-fold) and CRRT dose achieved (effluent flow rate interquartile range (IQR) 34 - 58 mL/min) that resulted in a wide range of trough concentrations, there was a consistent association between increasing eTRCL and decreased trough concentration for piperacillin, tazobactam, and vancomycin (p<0.05).
Conclusion. Future antibiotic dosing algorithms to improve the adequacy and consistency of blood antibiotic concentrations in critically ill patients requiring CRRT should take eTRC into account.
著者G Joynt, G Choi, J Roberts, J Lipman, A Lee, SMARRT Study Group
會議名稱2019 National Annual Congress of the Critical Care Society of Southern Africa
會議開始日28.08.2019
會議完結日01.09.2019
會議地點Cape Town
會議國家/地區南非
會議論文集題名Southern African Journal of Critical Care
出版年份2019
月份7
卷號35
期次1
出版社HEALTH & MEDICAL PUBLISHING GROUP
頁次28 - 28
國際標準期刊號1562-8264
語言美式英語

上次更新時間 2020-13-05 於 17:19