Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia.
OBJECTIVE
To determine the steady-state plasma and epithelial lining fluid concentrations of cefepime administered in continuous infusion in critically ill patients with severe bacterial pneumonia.


METHODS
Prospective, open-label study.


METHODS
An intensive care unit and research ward in a university hospital.


METHODS
Twenty adult patients with severe nosocomial bacterial pneumonia on mechanical ventilation were enrolled.


METHODS
All subjects received a 30-min intravenous infusion of cefepime 2 g followed by a continuous infusion of 4 g over 24 hrs. The concentrations of cefepime in plasma and epithelial lining fluid were determined at steady state after 48 hrs of therapy with high performance liquid chromatography.


RESULTS
The mean +/- sd steady-state plasma and epithelial lining fluid concentrations of cefepime 4 g in continuous infusion were 13.5 +/- 3.3 microg/mL and 14.1 +/- 2.8 microg/mL, respectively, with a mean percentage penetration of cefepime into epithelial lining fluid of about 100%.


CONCLUSIONS
The administration of 4 g of cefepime in continuous infusion in critically ill patients with severe nosocomial pneumonia appears to optimize the pharmacodynamic profile of this beta-lactam by constantly providing concentrations in excess of minimal inhibitory concentration of most of susceptible organisms over the course of therapy in both serum and epithelial lining fluid.
Boselli
Emmanuel
E
Department of Anesthesiology and Intensive Care, Hôtel-Dieu Hospital, Lyon, France.
Breilh
Dominique
D
Duflo
Frédéric
F
Saux
Marie-Claude
MC
Debon
Richard
R
Chassard
Dominique
D
Allaouchiche
Bernard
B
D000368:Aged; D018893:Bronchoalveolar Lavage; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology* / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D003428:Cross Infection / Q000188:drug therapy; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011446:Prospective Studies; D020545:Respiratory Mucosa / Q000378:metabolism*
D002511:Cephalosporins; D000077723:Cefepime