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Higher than standard dosing regimen are needed to achieve optimal antibiotic exposure in critically ill patients with augmented renal clearance receiving piperacillin-tazobactam administered by continuous infusion

dc.rights.licenseopenen_US
dc.contributor.authorCARRIÉ, Cédric
dc.contributor.authorLEGERON, Rachel
dc.contributor.authorPETIT, Laurent
dc.contributor.authorOLLIVIER, Julien
dc.contributor.authorCOTTENCEAU, Vincent
dc.contributor.authorD'HOUDAIN, Nicolas
dc.contributor.authorBOYER, Philippe
dc.contributor.authorLAFITTE, Mélanie
hal.structure.identifierBiologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
dc.contributor.authorXUEREB, Fabien
dc.contributor.authorSZTARK, François
hal.structure.identifierBiologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
dc.contributor.authorBREILH, Dominique
dc.contributor.authorBIAIS, Matthieu
dc.date.accessioned2020
dc.date.available2020
dc.date.issued2018
dc.identifier.issn0883-9441en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/20878
dc.description.abstractEnPurpose To determine whether augmented renal clearance (ARC) impacts negatively on piperacillin-tazobactam unbound concentrations in critically ill patients receiving 16 g/2 g/day administered continuously. Material and methods Fifty nine critically ill patients without renal impairment underwent 24-h creatinine clearance (Cr CL ) measurement and therapeutic drug monitoring during the first three days of antimicrobial therapy by piperacillin-tazobactam. The main outcome was the rate of piperacillin underexposure, defined by at least one of three samples under 16 mg/L. Monte Carlo simulation was performed to predict the distribution of piperacillin concentrations for various Cr CL and minimal inhibitory concentration (MIC) values. Results The rate of piperacillin underexposure was 19%, significantly higher in ARC patients (0 vs. 31%, p = .003). A threshold of Cr CL ≥ 170 mL/min had a sensitivity and specificity of 1 (95%CI: 0.79–1) and 0.69 (95%CI: 0.61–0.76) to predict piperacillin underexposure. In ARC patients, a 20 g/2.5 g/24 h PTZ dosing regimen was associated with the highest probability to reach the 16 mg/L empirical target, without risk of excessive dosing. Conclusions When targeting a theoretical MIC at the upper limit of the susceptibility range, the desirable target (100%fT >16 ) may not be achieved in patients with Cr CL ≥ 170 mL/min receiving PTZ 16 g/2 g/day administered continuously.
dc.language.isoENen_US
dc.subjectArticle CLINIQUE
dc.title.enHigher than standard dosing regimen are needed to achieve optimal antibiotic exposure in critically ill patients with augmented renal clearance receiving piperacillin-tazobactam administered by continuous infusion
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.jcrc.2018.08.026en_US
dc.subject.halSciences du Vivant [q-bio]/Médecine humaine et pathologieen_US
bordeaux.journalJournal of Critical Careen_US
bordeaux.page66–71en_US
bordeaux.volume48en_US
bordeaux.hal.laboratoriesBiologie des maladies cardiovasculaires - U1034en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.exportfalse
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