title: Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hôtel-Dieu Hospital, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boselli
authors.forename: Dominique
authors.initials: D
authors.lastname: Breilh
authors.forename: Frédéric
authors.initials: F
authors.lastname: Duflo
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Saux
authors.forename: Richard
authors.initials: R
authors.lastname: Debon
authors.forename: Dominique
authors.initials: D
authors.lastname: Chassard
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: 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*
chemical_list: D002511:Cephalosporins; D000077723:Cefepime