DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current -Lactam Antibiotic Doses Sufficient for Critically Ill Patients?

6533b7d9fe1ef96bd126d741

RESEARCH PRODUCT

DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current -Lactam Antibiotic Doses Sufficient for Critically Ill Patients?

Roberts Ja Lipman J Starr T Wallis Sc Paul Sk Margarit Ribas A De Waele Jj De Crop L Spapen H Wauters J Dugernier T Jorens P Dapper I De Backer D Taccone Fs Rello J Ruano L Afonso E Alvarez Lerma F Gracia Arnillas Mp Fernández F Feijoo N Bardolet N Rovira A Garro P Colon D Castillo C Fernado J Lopez Mj Fernandez Jl Arribas Am Teja Jl Ots E Carlos Montejo J Catalan M Prieto I Gonzalo G Galvan B Blasco Ma Meyer E Del Nogal F Vidaur L Sebastian R Garde Pm Martin Velasco Mdel M Zaragoza Crespo R Esperatti M Torres A Montravers P Baldesi O Dupont H Mahjoub Y Lasocki S Constantin Jm Payen Jf Martin C Albanese J Malledant Y Pottecher J Lefrant Jy Jaber S Joannes Boyau O Orban C Ostermann M Mckenzie C Berry W Smith J Lei K Rubulotta F Gordon A Brett S Stotz M Templeton M Rhodes A Ebm C Moran C Kaukonen Km Pettilä V Dimopoulos G Koulenti D Xristodoulou A Theodorou V Kouliatsis G Sertaridou E Anthopoulos G Choutas G Rantis T Karatzas S Balla M Papanikolaou M Myrianthefs P Gavala A Fildisis G Koutsoukou A Kyriakopoulou M Petrochilou K Kompoti M Michalia M Clouva Molyvdas Fm Gkiokas G Nikolakopoulos F Psychogiou V Malliotakis P Akoumianaki E Lilitsis E Koulouras V Nakos G Kalogirou M Komnos A Zafeiridis T Chaintoutis C Arvaniti K Matamis D Chaintoutis C Kydona C Gritsi Gerogianni N Giasnetsova T Giannakou M Soultati I Chytas I Antoniadou E Antipa E Lathyris D Koukoubani T Paraforou T Spiropoulou K Bekos V Spring A Kalatzi T Nikolaou H Laskou M Strouvalis I Aloizos S Kapogiannis S Soldatou O Bassetti M Adembri C Villa G Montalto F Strano Mt Ranieri Vm Sandroni C De Pascale G Molin A Pelosi P Montagnani L Urbino R Mastromauro I De Rosa Fg Ranieri Vm Cardoso T Afonso S Gonçalves Pereira J Baptista Jp Akova M Ozveren A.Antonino Giarratano Santi Maurizio Raineri Andrea Cortegiani

subject

Male International Cooperation Antibiotics adverse event intensive care unit law.invention 0302 clinical medicine meropenem Models [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases adverse events; continuous infusion; extended infusion; pharmacodynamics; pharmacokinetics; Aged; Anti-Bacterial Agents; Bacterial Infections; Blood Chemical Analysis; Female; Humans; Intensive Care Units; International Cooperation; Male; Microbial Sensitivity Tests; Middle Aged; Models Statistical; Prospective Studies; Treatment Outcome; beta-Lactams; Critical Illness antibiotic therapy Prospective Studies amoxicillin plus clavulanic acid ComputingMilieux_MISCELLANEOUS beta lactam antibiotic APACHE 0303 health sciences critical illne adult clinical trial 3. Good health continuous infusion; extended infusion; adverse events; pharmacokinetics; pharmacodynamics.antiinfective agent [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology priority journal disease severity beta-Lactam statistical model Aged prospective study Human Microbiology (medical)medicine.medical_specialty drug exposure Critical Illness Immunology bloodstream infection Microbial Sensitivity Tests piperacillin plus tazobactam beta-Lactams Microbiology beta lactam abdominal infection 03 medical and health sciences critically ill patient Intensive care Anti-Bacterial Agent cefepime pharmacodynamics Humans Dosing Adverse effect Aged Models Statistical 030306 microbiology Odds ratio major clinical study mortality antibiotic sensitivity ceftriaxone Prospective Studie multicenter study pharmacodynamics.ampicillin Blood Chemical Analysis Ceftazidime Settore MED/41 - Anestesiologia Interquartile range law 030212 general & internal medicine pharmacokinetic lung infection Microbial Sensitivity Test article Bacterial Infections Middle Aged Statistical continuous infusion Intensive care unit Anti-Bacterial Agents extended infusion Intensive Care Units Infectious Diseases Treatment Outcome adverse events; continuous infusion; extended infusion; pharmacodynamics; pharmacokinetics; Aged; Anti-Bacterial Agents; Bacterial Infections; Blood Chemical Analysis; Female; Humans; Intensive Care Units; International Cooperation; Male; Microbial Sensitivity Tests; Middle Aged; Models Statistical; Prospective Studies; Treatment Outcome; beta-Lactams; Critical Illness; Microbiology (medical); Infectious Diseases cefazolin [SDV.IMM]Life Sciences [q-bio]/Immunology blood sampling Female pharmacokinetics medicine.drug medicine.drug_class prevalence doripenem minimum inhibitory concentration Bacterial Infection Internal medicine medicine controlled study blood analysi business.industry Blood Chemical Analysi adverse events Surgery pharmacodynamic drug blood level business

description

Background. Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether α-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome.Methods. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 α-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f TMIC) and 100% (100% f T MIC) of the dosing interval. We used skewed logistic regression to describe the effect of antibiotic exposure on patient outcome.Results. We included 384 patients (361 evaluable patients) across 68 hospitals. The median age was 61 (interquartile range [IQR], 48-73) years, the median Acute Physiology and Chronic Health Evaluation II score was 18 (IQR, 14-24), and 65% of patients were male. Of the 248 patients treated for infection, 16% did not achieve 50% f TMIC and these patients were 32% less likely to have a positive clinical outcome (odds ratio [OR], 0.68; P =. 009). Positive clinical outcome was associated with increasing 50% f TMIC and 100% f TMIC ratios (OR, 1.02 and 1.56, respectively; P <. 03), with significant interaction with sickness severity status.Conclusions. Infected critically ill patients may have adverse outcomes as a result of inadeqaute antibiotic exposure; a paradigm change to more personalized antibiotic dosing may be necessary to improve outcomes for these most seriously ill patients. © 2014 The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

year	journal	country	edition	language
2014-01-14

10.1093/cid/ciu027 https://hal.umontpellier.fr/hal-01954093