title: Continuous versus intermittent infusion of cefepime in neurosurgical patients with post-operative intracranial infections.
abstract: Cefepime is administered as an intermittent infusion (II); however, continuous infusion (CI) may be advantageous because β-lactam antibiotics exhibit time-dependent antibacterial activity. This retrospective, non-randomised, comparative study included 68 neurosurgical patients with post-operative intracranial infections treated with 4g/day cefepime over 24h as a CI (n=34) or 2g every 12h as II (n=34). CI controlled the intracranial infection more rapidly and effectively than II (6.6±1.9 days vs. 7.8±2.6 days; P=0.036). By considering the minimum inhibitory concentrations (MICs) to be 4μg/mL and 8μg/mL, the percentage of time when the cefepime plasma or CSF concentrations were higher than the MIC (%T>MIC) was calculated for each patient. For plasma cefepime concentrations, the %T(>MIC) in the CI group was higher than in the II group (for MICs of 8μg/mL, 100% vs. 75%, respectively). The mean calculated area under the curve (AUC) in the CI group was similar to the II group (1197.99±72.15μgh/mL vs. 890.84±140.78μgh/mL; P=0.655). For CSF cefepime concentrations, the %T(>MIC) in the CI group was higher than in the II group (for MICs of 4μg/mL and 8μg/mL, 83.3% and 75% vs. 25% and 0%, respectively). The mean calculated AUC for the CI group was higher than the II group (220.56±13.59μgh/mL vs. 86.34±5.69μgh/mL; P=0.003). Therefore, CI of cefepime significantly enhanced the antibacterial effect and reduced the treatment duration in neurosurgical patients with post-operative intracranial infections.
authors.affiliation: Department of Critical Care Medicine, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, PR China.
authors.forename: Huawei
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, PR China.
authors.forename: Shengyue
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, PR China. Electronic address: zpl7755@126.com.
authors.forename: Pengli
authors.initials: P
authors.lastname: Zhu
authors.affiliation: Department of Critical Care Medicine, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, PR China. Electronic address: xxm_fxyy@sina.cn.
authors.forename: Xiuming
authors.initials: X
authors.lastname: Xi
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010949:Plasma / Q000737:chemistry; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime
keywords: Cefepime; Continuous infusion; Intermittent infusion; Intracranial infection; Minimum inhibitory concentration