title: Meropenem removal in critically ill patients undergoing sustained low-efficiency dialysis (SLED).
abstract: BACKGROUND
  The purpose of this study was to examine the removal of meropenem during an 8-h sustained low-efficiency dialysis (SLED) session. Using a minimum inhibitory concentration (MIC) = 2 microg/mL as our reference point, we also evaluated the therapeutic adequacy of dosing meropenem as 1 g every 12 h during SLED.
  
  
  METHODS
  This was a prospective, open-label study involving 10 intensive care unit patients with renal failure needing SLED. Meropenem was dosed as 1 g every 12 h. To ensure a steady state, the patients received at least two doses prior to the study. SLED was initiated at least 2 h after the last meropenem dose, and each session was at least 8 h. Blood samples were collected during SLED at 0, 2, 4 and 8 h. The 8-h sample approximated the trough level. After centrifuging the samples, the supernatants were analysed by high-performance liquid chromatography.
  
  
  RESULTS
  Most patients were male with a mean age of 63.7 years and a mean weight of 88.9 kg. The SLED prescription was based on each patient's needs, and the blood flow, dialysate flow and ultrafiltration rates varied by up to 150 mL/min. The mean reduction of plasma meropenem concentration was 79.1 +/- 7.3%, and the mean half-life was 3.6 +/- 0.8 h during the 8-h SLED. Significantly more meropenem was removed in the first 4 h of SLED compared with the rest of the sessions. The mean plasma trough concentration was 4 +/- 1.6 microg/mL.
  
  
  CONCLUSIONS
  Meropenem was significantly removed from the blood compartment during SLED. Dosing 1 g of meropenem every 12 h during a typical 8-h SLED session maintains adequate plasma concentrations.
authors.affiliation: Department of Medicine, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Bronx, NY 10467, USA. pdeshpan@montefiore.org
authors.forename: Priya
authors.initials: P
authors.lastname: Deshpande
authors.forename: Julie
authors.initials: J
authors.lastname: Chen
authors.forename: Anita
authors.initials: A
authors.lastname: Gofran
authors.forename: Marianna
authors.initials: M
authors.lastname: Murea
authors.forename: Ladan
authors.initials: L
authors.lastname: Golestaneh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood*; D015331:Cohort Studies; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000379:methods*; D013845:Thienamycins / Q000097:blood*; D013997:Time Factors; D014462:Ultrafiltration
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem