title: Drastic reduction of piperacillin-tazobactam concentrations in an in-vitro model of continuous venovenous hemofiltration: proposal of an innovative modality of administration to maintain them at constant concentration.
abstract: OBJECTIVE
  Critically-ill patients often undergo continuous renal replacement therapy (CRRT) and need antimicrobial therapy. Piperacillin and tazobactam (Pip-Tzb) are cleared by CRRT. Our aim is to evaluate Pip-Tzb removal in an in-vitro-single-pool-model of continuous-veno-venous-hemofiltration (CVVH); we test a new method of Pip-Tzb administration during CRRT assuring constant levels of concentrations above the minimum inhibitory concentration (MIC).
  
  
  METHODS
  In an in-vitro-single-pool-model of CVVH, two solutions (Protein-Free-Solution, PFS and Fresh-Frozen- Plasma, FFP) added with Pip-Tzb were tested for Pip-Tzb removal and adsorption. Then, to keep concentrations constantly above the MIC during CVVH, we add Pip-Tzb in the reinfusion bags.
  
  
  RESULTS
  Pip-Tzb rapidly decreased than the MIC during CVVH. The adsorption was irrelevant in the test with FPS. Adding Pip-Tzb in the reinfusion bags of the CVVH system, we observed constant concentrations of Pip-Tzb over time.
  
  
  CONCLUSIONS
  The association of Pip-Tzb is rapidly cleared with a real risk of inadequate dosages in patients undergoing CRRT. Adding Pip-Tzb in the reinfusion bags above the MIC, we obtained stability of concentrations during CVVH.
authors.forename: Michele
authors.initials: M
authors.lastname: Ferrannini
authors.forename: Pasquale
authors.initials: P
authors.lastname: Niscola
authors.forename: Clorinda
authors.initials: C
authors.lastname: Falcone
authors.forename: Annalisa
authors.initials: A
authors.lastname: Noce
authors.forename: Anna
authors.initials: A
authors.lastname: Pastore
authors.forename: Gianna
authors.initials: G
authors.lastname: Di Giovamberardino
authors.forename: Andrea
authors.initials: A
authors.lastname: Tendas
authors.forename: Laura
authors.initials: L
authors.lastname: Scaramucci
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Daniele
authors.affiliation: Piazzale dell'Umanesimo, 10, 00144 - Roma, Italy. m.ferrannini@inwind.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Palumbo
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000032:analysis / Q000097:blood; D006440:Hemofiltration; D066298:In Vitro Techniques; D008657:Metabolic Clearance Rate; D008954:Models, Biological; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000032:analysis / Q000097:blood; D010878:Piperacillin / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D000077725:Piperacillin, Tazobactam Drug Combination
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin