Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?
Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the cl...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-07-01
|
| Series: | Microorganisms |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-2607/9/7/1505 |
| _version_ | 1797526602951688192 |
|---|---|
| author | Claire Roger Benjamin Louart |
| author_facet | Claire Roger Benjamin Louart |
| author_sort | Claire Roger |
| collection | DOAJ |
| description | Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals. |
| first_indexed | 2024-03-10T09:31:40Z |
| format | Article |
| id | doaj.art-a350e9df68a240858a20f9e147d7dd2e |
| institution | Directory Open Access Journal |
| issn | 2076-2607 |
| language | English |
| last_indexed | 2024-03-10T09:31:40Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Microorganisms |
| spelling | doaj.art-a350e9df68a240858a20f9e147d7dd2e2023-11-22T04:26:48ZengMDPI AGMicroorganisms2076-26072021-07-0197150510.3390/microorganisms9071505Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?Claire Roger0Benjamin Louart1Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, CEDEX 9, 30029 Nîmes, FranceDepartment of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, CEDEX 9, 30029 Nîmes, FranceBeta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.https://www.mdpi.com/2076-2607/9/7/1505antimicrobialsnephrotoxicityneurotoxicityadverse eventscritically ill patients |
| spellingShingle | Claire Roger Benjamin Louart Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? Microorganisms antimicrobials nephrotoxicity neurotoxicity adverse events critically ill patients |
| title | Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? |
| title_full | Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? |
| title_fullStr | Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? |
| title_full_unstemmed | Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? |
| title_short | Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage? |
| title_sort | beta lactams toxicity in the intensive care unit an underestimated collateral damage |
| topic | antimicrobials nephrotoxicity neurotoxicity adverse events critically ill patients |
| url | https://www.mdpi.com/2076-2607/9/7/1505 |
| work_keys_str_mv | AT claireroger betalactamstoxicityintheintensivecareunitanunderestimatedcollateraldamage AT benjaminlouart betalactamstoxicityintheintensivecareunitanunderestimatedcollateraldamage |