Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study
To evaluate target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients. Patients were sampled on a daily basis. TZP or MER concentrations were evaluated during the first two days antibiotic therapy. The lower limit of the t...
Gespeichert in:
| Veröffentlicht in: | Journal of critical care 2019-08, Vol.52, p.75-79 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 79 |
|---|---|
| container_issue | |
| container_start_page | 75 |
| container_title | Journal of critical care |
| container_volume | 52 |
| creator | Dhaese, Sofie A.M. Thooft, Alexander D.J. Farkas, Andras Lipman, Jeffrey Verstraete, Alain G. Stove, Veronique Roberts, Jason A. De Waele, Jan J. |
| description | To evaluate target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients.
Patients were sampled on a daily basis. TZP or MER concentrations were evaluated during the first two days antibiotic therapy. The lower limit of the target range was defined as unbound concentrations equaling 4 times the epidemiological cutoff value of P. aeruginosa. The upper limit of the target range was based on the risk of toxicity, i.e. unbound concentrations >160 mg/L for TZP and > 45 mg/L for MER. Multivariable logistic regression was used to evaluate factors associated with target attainment.
Data from 253 patients were analyzed. Overall, 76/205 (37.1%) and 36/48 (75%) of the patients receiving TZP or MER respectively, attained target concentrations. In multivariable analysis, estimated creatinine clearance was identified as a risk factor for target non-attainment (OR 0.988, 95%CI [0.982;0.994]). Patients receiving MER were more likely to attain target concentrations compared with patients receiving TZP (OR 6.02, 95%CI [2.12;18.4]).
Target attainment of empiric antibiotic therapy in critically ill patients was low (37%) for TZP and moderate (75%) for MER, despite the use of a loading dose and despite optimization of the mode of infusion.
•Target attainment of empiric, continuous infusion TZP and MER is low to moderate.•Estimated creatinine clearance was identified as predictor of target non-attainment.•Strategies to optimize antimicrobial dosing in ICU patients are urgently needed. |
| doi_str_mv | 10.1016/j.jcrc.2019.04.013 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2210324111</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0883944119300061</els_id><sourcerecordid>2210324111</sourcerecordid><originalsourceid>FETCH-LOGICAL-c384t-a553e8c4c28b760071f2ece5725d3ecd6ea55e9999d7b2a017abf70e527a01e43</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhS1ERYfCC7BAltiwSeqfOD-ITVWVglSpm7K2HOcGOUrsYDsjTR-jT8wdTWHBot5Ylr97dM85hHzgrOSM15dTOdloS8F4V7KqZFy-IjuuVFO0NVevyY61rSy6quLn5G1KE2O8kVK9IeeSdW3dqHZHnm5MnA80m_gLMjU5G-cX8JmGkdrgs_Nb2BJ1ftySC56uboVorJtn5y-zeQy9sdks1PiBLhDDCh4WxKmNLjtrZhRHmK4mO5RNX-gVXWNIK9js9kBDnyDu8TN4M9OUt-HwjpyNZk7w_vm-ID-_3Txcfy_u7m9_XF_dFVa2VS6MUhJaW1nR9k3NWMNHARZUI9QgwQ41IAEdnqHphUHvph8bBko0-IBKXpDPJ13c5_cGKevFJQvzbDygZy0EZ1JUnHNEP_2HTmGLuPGRkl3NWiZqpMSJsmgwRRj1Gt1i4kFzpo-N6UkfG9PHxjSrNDaGQx-fpbd-geHfyN-KEPh6AgCz2DuIOlmM0sLgIoaoh-Be0v8DF76q-A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2239608026</pqid></control><display><type>article</type><title>Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study</title><source>Elsevier ScienceDirect Journals</source><creator>Dhaese, Sofie A.M. ; Thooft, Alexander D.J. ; Farkas, Andras ; Lipman, Jeffrey ; Verstraete, Alain G. ; Stove, Veronique ; Roberts, Jason A. ; De Waele, Jan J.</creator><creatorcontrib>Dhaese, Sofie A.M. ; Thooft, Alexander D.J. ; Farkas, Andras ; Lipman, Jeffrey ; Verstraete, Alain G. ; Stove, Veronique ; Roberts, Jason A. ; De Waele, Jan J.</creatorcontrib><description>To evaluate target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients.
Patients were sampled on a daily basis. TZP or MER concentrations were evaluated during the first two days antibiotic therapy. The lower limit of the target range was defined as unbound concentrations equaling 4 times the epidemiological cutoff value of P. aeruginosa. The upper limit of the target range was based on the risk of toxicity, i.e. unbound concentrations >160 mg/L for TZP and > 45 mg/L for MER. Multivariable logistic regression was used to evaluate factors associated with target attainment.
Data from 253 patients were analyzed. Overall, 76/205 (37.1%) and 36/48 (75%) of the patients receiving TZP or MER respectively, attained target concentrations. In multivariable analysis, estimated creatinine clearance was identified as a risk factor for target non-attainment (OR 0.988, 95%CI [0.982;0.994]). Patients receiving MER were more likely to attain target concentrations compared with patients receiving TZP (OR 6.02, 95%CI [2.12;18.4]).
Target attainment of empiric antibiotic therapy in critically ill patients was low (37%) for TZP and moderate (75%) for MER, despite the use of a loading dose and despite optimization of the mode of infusion.
•Target attainment of empiric, continuous infusion TZP and MER is low to moderate.•Estimated creatinine clearance was identified as predictor of target non-attainment.•Strategies to optimize antimicrobial dosing in ICU patients are urgently needed.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2019.04.013</identifier><identifier>PMID: 30986758</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Antibiotics ; Antimicrobial agents ; Continuous infusion ; Critically ill patients ; Drug dosages ; Electron tubes ; Empirical therapy ; Intensive care ; Meropenem ; Neurotoxicity ; Observational studies ; Pathogens ; Patients ; Piperacillin ; Target attainment ; Toxicology</subject><ispartof>Journal of critical care, 2019-08, Vol.52, p.75-79</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-a553e8c4c28b760071f2ece5725d3ecd6ea55e9999d7b2a017abf70e527a01e43</citedby><cites>FETCH-LOGICAL-c384t-a553e8c4c28b760071f2ece5725d3ecd6ea55e9999d7b2a017abf70e527a01e43</cites><orcidid>0000-0002-2252-7167 ; 0000-0001-6218-435X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944119300061$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30986758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhaese, Sofie A.M.</creatorcontrib><creatorcontrib>Thooft, Alexander D.J.</creatorcontrib><creatorcontrib>Farkas, Andras</creatorcontrib><creatorcontrib>Lipman, Jeffrey</creatorcontrib><creatorcontrib>Verstraete, Alain G.</creatorcontrib><creatorcontrib>Stove, Veronique</creatorcontrib><creatorcontrib>Roberts, Jason A.</creatorcontrib><creatorcontrib>De Waele, Jan J.</creatorcontrib><title>Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>To evaluate target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients.
Patients were sampled on a daily basis. TZP or MER concentrations were evaluated during the first two days antibiotic therapy. The lower limit of the target range was defined as unbound concentrations equaling 4 times the epidemiological cutoff value of P. aeruginosa. The upper limit of the target range was based on the risk of toxicity, i.e. unbound concentrations >160 mg/L for TZP and > 45 mg/L for MER. Multivariable logistic regression was used to evaluate factors associated with target attainment.
Data from 253 patients were analyzed. Overall, 76/205 (37.1%) and 36/48 (75%) of the patients receiving TZP or MER respectively, attained target concentrations. In multivariable analysis, estimated creatinine clearance was identified as a risk factor for target non-attainment (OR 0.988, 95%CI [0.982;0.994]). Patients receiving MER were more likely to attain target concentrations compared with patients receiving TZP (OR 6.02, 95%CI [2.12;18.4]).
Target attainment of empiric antibiotic therapy in critically ill patients was low (37%) for TZP and moderate (75%) for MER, despite the use of a loading dose and despite optimization of the mode of infusion.
•Target attainment of empiric, continuous infusion TZP and MER is low to moderate.•Estimated creatinine clearance was identified as predictor of target non-attainment.•Strategies to optimize antimicrobial dosing in ICU patients are urgently needed.</description><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Continuous infusion</subject><subject>Critically ill patients</subject><subject>Drug dosages</subject><subject>Electron tubes</subject><subject>Empirical therapy</subject><subject>Intensive care</subject><subject>Meropenem</subject><subject>Neurotoxicity</subject><subject>Observational studies</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Piperacillin</subject><subject>Target attainment</subject><subject>Toxicology</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc1u1DAUhS1ERYfCC7BAltiwSeqfOD-ITVWVglSpm7K2HOcGOUrsYDsjTR-jT8wdTWHBot5Ylr97dM85hHzgrOSM15dTOdloS8F4V7KqZFy-IjuuVFO0NVevyY61rSy6quLn5G1KE2O8kVK9IeeSdW3dqHZHnm5MnA80m_gLMjU5G-cX8JmGkdrgs_Nb2BJ1ftySC56uboVorJtn5y-zeQy9sdks1PiBLhDDCh4WxKmNLjtrZhRHmK4mO5RNX-gVXWNIK9js9kBDnyDu8TN4M9OUt-HwjpyNZk7w_vm-ID-_3Txcfy_u7m9_XF_dFVa2VS6MUhJaW1nR9k3NWMNHARZUI9QgwQ41IAEdnqHphUHvph8bBko0-IBKXpDPJ13c5_cGKevFJQvzbDygZy0EZ1JUnHNEP_2HTmGLuPGRkl3NWiZqpMSJsmgwRRj1Gt1i4kFzpo-N6UkfG9PHxjSrNDaGQx-fpbd-geHfyN-KEPh6AgCz2DuIOlmM0sLgIoaoh-Be0v8DF76q-A</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Dhaese, Sofie A.M.</creator><creator>Thooft, Alexander D.J.</creator><creator>Farkas, Andras</creator><creator>Lipman, Jeffrey</creator><creator>Verstraete, Alain G.</creator><creator>Stove, Veronique</creator><creator>Roberts, Jason A.</creator><creator>De Waele, Jan J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2252-7167</orcidid><orcidid>https://orcid.org/0000-0001-6218-435X</orcidid></search><sort><creationdate>201908</creationdate><title>Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study</title><author>Dhaese, Sofie A.M. ; Thooft, Alexander D.J. ; Farkas, Andras ; Lipman, Jeffrey ; Verstraete, Alain G. ; Stove, Veronique ; Roberts, Jason A. ; De Waele, Jan J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-a553e8c4c28b760071f2ece5725d3ecd6ea55e9999d7b2a017abf70e527a01e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Continuous infusion</topic><topic>Critically ill patients</topic><topic>Drug dosages</topic><topic>Electron tubes</topic><topic>Empirical therapy</topic><topic>Intensive care</topic><topic>Meropenem</topic><topic>Neurotoxicity</topic><topic>Observational studies</topic><topic>Pathogens</topic><topic>Patients</topic><topic>Piperacillin</topic><topic>Target attainment</topic><topic>Toxicology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhaese, Sofie A.M.</creatorcontrib><creatorcontrib>Thooft, Alexander D.J.</creatorcontrib><creatorcontrib>Farkas, Andras</creatorcontrib><creatorcontrib>Lipman, Jeffrey</creatorcontrib><creatorcontrib>Verstraete, Alain G.</creatorcontrib><creatorcontrib>Stove, Veronique</creatorcontrib><creatorcontrib>Roberts, Jason A.</creatorcontrib><creatorcontrib>De Waele, Jan J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhaese, Sofie A.M.</au><au>Thooft, Alexander D.J.</au><au>Farkas, Andras</au><au>Lipman, Jeffrey</au><au>Verstraete, Alain G.</au><au>Stove, Veronique</au><au>Roberts, Jason A.</au><au>De Waele, Jan J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2019-08</date><risdate>2019</risdate><volume>52</volume><spage>75</spage><epage>79</epage><pages>75-79</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>To evaluate target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients.
Patients were sampled on a daily basis. TZP or MER concentrations were evaluated during the first two days antibiotic therapy. The lower limit of the target range was defined as unbound concentrations equaling 4 times the epidemiological cutoff value of P. aeruginosa. The upper limit of the target range was based on the risk of toxicity, i.e. unbound concentrations >160 mg/L for TZP and > 45 mg/L for MER. Multivariable logistic regression was used to evaluate factors associated with target attainment.
Data from 253 patients were analyzed. Overall, 76/205 (37.1%) and 36/48 (75%) of the patients receiving TZP or MER respectively, attained target concentrations. In multivariable analysis, estimated creatinine clearance was identified as a risk factor for target non-attainment (OR 0.988, 95%CI [0.982;0.994]). Patients receiving MER were more likely to attain target concentrations compared with patients receiving TZP (OR 6.02, 95%CI [2.12;18.4]).
Target attainment of empiric antibiotic therapy in critically ill patients was low (37%) for TZP and moderate (75%) for MER, despite the use of a loading dose and despite optimization of the mode of infusion.
•Target attainment of empiric, continuous infusion TZP and MER is low to moderate.•Estimated creatinine clearance was identified as predictor of target non-attainment.•Strategies to optimize antimicrobial dosing in ICU patients are urgently needed.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30986758</pmid><doi>10.1016/j.jcrc.2019.04.013</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-2252-7167</orcidid><orcidid>https://orcid.org/0000-0001-6218-435X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0883-9441 |
| ispartof | Journal of critical care, 2019-08, Vol.52, p.75-79 |
| issn | 0883-9441 1557-8615 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2210324111 |
| source | Elsevier ScienceDirect Journals |
| subjects | Antibiotics Antimicrobial agents Continuous infusion Critically ill patients Drug dosages Electron tubes Empirical therapy Intensive care Meropenem Neurotoxicity Observational studies Pathogens Patients Piperacillin Target attainment Toxicology |
| title | Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A prospective observational study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T07%3A11%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20target%20attainment%20of%20continuous%20infusion%20piperacillin/tazobactam%20and%20meropenem%20in%20critically%20ill%20patients:%20A%20prospective%20observational%20study&rft.jtitle=Journal%20of%20critical%20care&rft.au=Dhaese,%20Sofie%20A.M.&rft.date=2019-08&rft.volume=52&rft.spage=75&rft.epage=79&rft.pages=75-79&rft.issn=0883-9441&rft.eissn=1557-8615&rft_id=info:doi/10.1016/j.jcrc.2019.04.013&rft_dat=%3Cproquest_cross%3E2210324111%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2239608026&rft_id=info:pmid/30986758&rft_els_id=S0883944119300061&rfr_iscdi=true |