Impact of β-lactam antibiotic therapeutic drug monitoring on dose adjustments in critically ill patients undergoing continuous renal replacement therapy.
The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC). A total of 111 TDM samples from 76 patients (46 male) with a mean ± standard deviation age of 56.6 ± 15.9 years and weight of 89.1 ± 25.8 kg were identified. The duration of antibiotic therapy was between 2 days and 42 days. TDM identified a need for dose modification of β-lactam antibiotics in 39 (35%) instances; in 27 (24%) samples, TDM values resulted in decreasing the prescribed dose of β-lactam antibiotic whereas an increase in the prescribed dose occurred in 12 (11%) cases. In patients treated for hospital-acquired pneumonia and primary or secondary bacteraemia, the dose was required to be decreased in 10/25 (40%) and 7/46 (15%) cases, respectively, to attain target concentrations. β-Lactam TDM is a useful tool for guiding drug dosing in complex patients such as those receiving CRRT. Although over one-third of patients manifested concentrations outside the therapeutic range, most of these CRRT patients had excessive β-lactam concentrations.
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Research, ICON Cancer Foundation, Brisbane, QLD, Australia.
Caleb J P
CJP
Economou
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.
Gloria
G
Wong
Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Brett
B
McWhinney
Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Jacobus P J
JPJ
Ungerer
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Jeffrey
J
Lipman
Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, QLD, Australia. Electronic address: j.roberts2@uq.edu.au.
Jason A
JA
Roberts
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D003422:Critical Care; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D047090:beta-Lactams
Continuous renal replacement therapy; Pharmacodynamics; Pharmacokinetics; TDM; Therapeutic drug monitoring; β-Lactam antibiotic