Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections
(1) Objectives: To describe the relationship between pharmacokinetic/pharmacodynamic (PK/PD) target attainment of continuous infusion (CI) piperacillin–tazobactam or meropenem monotherapy and microbiological outcome in a case series of urological patients with documented Gram-negative infections. (2...
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MDPI AG
2023-08-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/9/1388 |
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| author | Pasquale Maria Berrino Milo Gatti Matteo Rinaldi Eugenio Brunocilla Pierluigi Viale Federico Pea |
| author_facet | Pasquale Maria Berrino Milo Gatti Matteo Rinaldi Eugenio Brunocilla Pierluigi Viale Federico Pea |
| author_sort | Pasquale Maria Berrino |
| collection | DOAJ |
| description | (1) Objectives: To describe the relationship between pharmacokinetic/pharmacodynamic (PK/PD) target attainment of continuous infusion (CI) piperacillin–tazobactam or meropenem monotherapy and microbiological outcome in a case series of urological patients with documented Gram-negative infections. (2) Methods: Patients admitted to the urology ward who were treated with CI piperacillin–tazobactam or meropenem monotherapy for documented Gram-negative infections and underwent real-time therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program from June 2021 to May 2023 were retrospectively retrieved. Average steady-state (C<sub>ss</sub>) piperacillin–tazobactam and meropenem concentrations were determined, and the free fractions (<i>f</i>C<sub>ss</sub>) were calculated. Optimal PK/PD target attainments were defined as an <i>f</i>C<sub>ss</sub>/MIC ratio >4 for CI meropenem and an <i>f</i>C<sub>ss</sub>/MIC ratio of piperacillin >4 coupled with an <i>f</i>C<sub>ss</sub>/C<sub>T</sub> ratio for tazobactam >1 for piperacillin–tazobactam (joint PK/PD target). The relationship between beta-lactam PK/PD targets and microbiological outcome was explored. (3) Results: Sixteen urologic patients with documented Gram-negative infections (62.5% complicated urinary tract infections (cUTI)) had 30 TDM-guided ECPAs. At first TDM assessment, beta-lactam dosing adjustments were recommended in 11 out of 16 cases (68.75%, of which 62.5% decreases and 6.25% increases). Overall, beta-lactam dosing adjustments were recommended in 14 out of 30 ECPAs (46.6%). Beta-lactam PK/PD target attainments were optimal in 100.0% of cases. Microbiological failure occurred in two patients, both developing beta-lactam resistance. (4) Conclusion: A TDM-guided ECPA program may allow for optimizing beta-lactam treatment in urologic patients with documented Gram-negative infections, ensuring microbiological eradication in most cases. |
| first_indexed | 2024-03-10T23:06:08Z |
| format | Article |
| id | doaj.art-1b97b55ee03e4291adae54e742dbd7d7 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T23:06:08Z |
| publishDate | 2023-08-01 |
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| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-1b97b55ee03e4291adae54e742dbd7d72023-11-19T09:17:05ZengMDPI AGAntibiotics2079-63822023-08-01129138810.3390/antibiotics12091388Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative InfectionsPasquale Maria Berrino0Milo Gatti1Matteo Rinaldi2Eugenio Brunocilla3Pierluigi Viale4Federico Pea5Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy(1) Objectives: To describe the relationship between pharmacokinetic/pharmacodynamic (PK/PD) target attainment of continuous infusion (CI) piperacillin–tazobactam or meropenem monotherapy and microbiological outcome in a case series of urological patients with documented Gram-negative infections. (2) Methods: Patients admitted to the urology ward who were treated with CI piperacillin–tazobactam or meropenem monotherapy for documented Gram-negative infections and underwent real-time therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program from June 2021 to May 2023 were retrospectively retrieved. Average steady-state (C<sub>ss</sub>) piperacillin–tazobactam and meropenem concentrations were determined, and the free fractions (<i>f</i>C<sub>ss</sub>) were calculated. Optimal PK/PD target attainments were defined as an <i>f</i>C<sub>ss</sub>/MIC ratio >4 for CI meropenem and an <i>f</i>C<sub>ss</sub>/MIC ratio of piperacillin >4 coupled with an <i>f</i>C<sub>ss</sub>/C<sub>T</sub> ratio for tazobactam >1 for piperacillin–tazobactam (joint PK/PD target). The relationship between beta-lactam PK/PD targets and microbiological outcome was explored. (3) Results: Sixteen urologic patients with documented Gram-negative infections (62.5% complicated urinary tract infections (cUTI)) had 30 TDM-guided ECPAs. At first TDM assessment, beta-lactam dosing adjustments were recommended in 11 out of 16 cases (68.75%, of which 62.5% decreases and 6.25% increases). Overall, beta-lactam dosing adjustments were recommended in 14 out of 30 ECPAs (46.6%). Beta-lactam PK/PD target attainments were optimal in 100.0% of cases. Microbiological failure occurred in two patients, both developing beta-lactam resistance. (4) Conclusion: A TDM-guided ECPA program may allow for optimizing beta-lactam treatment in urologic patients with documented Gram-negative infections, ensuring microbiological eradication in most cases.https://www.mdpi.com/2079-6382/12/9/1388piperacillin–tazobactammeropenemurologyGram-negative infectionsPK/PD target attainmentmicrobiological outcome |
| spellingShingle | Pasquale Maria Berrino Milo Gatti Matteo Rinaldi Eugenio Brunocilla Pierluigi Viale Federico Pea Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections Antibiotics piperacillin–tazobactam meropenem urology Gram-negative infections PK/PD target attainment microbiological outcome |
| title | Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections |
| title_full | Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections |
| title_fullStr | Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections |
| title_full_unstemmed | Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections |
| title_short | Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin–Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections |
| title_sort | pharmacokinetic pharmacodynamic target attainment of continuous infusion piperacillin tazobactam or meropenem and microbiological outcome among urologic patients with documented gram negative infections |
| topic | piperacillin–tazobactam meropenem urology Gram-negative infections PK/PD target attainment microbiological outcome |
| url | https://www.mdpi.com/2079-6382/12/9/1388 |
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