The Effect of Renal Replacement Therapy and Antibiotic Dose on Antibiotic Concentrations in Critically Ill Patients: Data From the Multinational Sampling Antibiotics in Renal Replacement Therapy Study.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Jason A RobertsSMARRT Study Collaborators and the ANZICS Clinical Trials Group

Abstract

The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and relate observed trough antibiotic concentrations to optimal targets. We performed a prospective, observational, multinational, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical, and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam, and vancomycin and related them to high- and low-target trough concentrations. We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8-fold) in antibiotic dosing regimens, RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/minute (interquartile range [IQR], 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (P < .05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin was 78.6 mg/L (49.5-127.3), tazobactam was 9.5 mg/L (6.3-14.2), and vancomycin was 14.3 mg...Continue Reading

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Citations

May 10, 2020·Intensive Care Medicine·Mohd H Abdul-AzizUNKNOWN Infections in the ICU and Sepsis Working Group of International Society of Antimicrobial Chemotherapy (ISAC)
Nov 24, 2020·The International Journal of Artificial Organs·Frédéric J BaudLionel Lamhaut
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Mar 17, 2021·Antimicrobial Agents and Chemotherapy·Mohammad H Al-ShaerCharles A Peloquin
Jul 28, 2021·Expert Review of Clinical Pharmacology·Quyen TuJason A Roberts
Aug 6, 2021·The International Journal of Artificial Organs·Frédéric J BaudLionel Lamhaut

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