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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AbstractBackground. 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.
All Author(s) ListG Joynt, G Choi, J Roberts, J Lipman, A Lee, SMARRT Study Group
Name of Conference2019 National Annual Congress of the Critical Care Society of Southern Africa
Start Date of Conference28/08/2019
End Date of Conference01/09/2019
Place of ConferenceCape Town
Country/Region of ConferenceSouth Africa
Proceedings TitleSouthern African Journal of Critical Care
Year2019
Month7
Volume Number35
Issue Number1
PublisherHEALTH & MEDICAL PUBLISHING GROUP
Pages28 - 28
ISSN1562-8264
LanguagesEnglish-United States

Last updated on 2020-13-05 at 17:19