Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice
Various studies have reported insufficient beta-lactam concentrations in critically ill patients. The extent to which therapeutic drug monitoring (TDM) in clinical practice can reduce insufficient antibiotic concentrations is an ongoing matter of investigation. We retrospectively evaluated routine m...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-03-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/3/131 |
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| author | Christina Scharf Michael Paal Ines Schroeder Michael Vogeser Rika Draenert Michael Irlbeck Michael Zoller Uwe Liebchen |
| author_facet | Christina Scharf Michael Paal Ines Schroeder Michael Vogeser Rika Draenert Michael Irlbeck Michael Zoller Uwe Liebchen |
| author_sort | Christina Scharf |
| collection | DOAJ |
| description | Various studies have reported insufficient beta-lactam concentrations in critically ill patients. The extent to which therapeutic drug monitoring (TDM) in clinical practice can reduce insufficient antibiotic concentrations is an ongoing matter of investigation. We retrospectively evaluated routine meropenem and piperacillin measurements in critically ill patients who received antibiotics as short infusions in the first year after initiating a beta-lactam TDM program. Total trough concentrations above 8.0 mg/L for meropenem and above 22.5 mg/L for piperacillin were defined as the breakpoints for target attainment. We included 1832 meropenem samples and 636 piperacillin samples. We found that 39.3% of meropenem and 33.6% of piperacillin samples did not reach the target concentrations. We observed a clear correlation between renal function and antibiotic concentration (meropenem, <i>r</i> = 0.53; piperacillin, <i>r</i> = 0.63). Patients with renal replacement therapy or creatinine clearance (CrCl) of <70 mL/min had high rates of target attainment with the standard dosing regimens. There was a low number of patients with a CrCl >100 mL/min that achieved the target concentrations with the maximum recommended dosage. Patients with impaired renal function only required TDM if toxic side effects were noted. In contrast, patients with normal renal function required different dosage regimens and TDM-guided therapy to reach the breakpoints of target attainment. |
| first_indexed | 2024-12-12T12:16:49Z |
| format | Article |
| id | doaj.art-d430d6e25c564edb8d8aa15bb5c8bd52 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-12-12T12:16:49Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-d430d6e25c564edb8d8aa15bb5c8bd522022-12-22T00:24:46ZengMDPI AGAntibiotics2079-63822020-03-019313110.3390/antibiotics9030131antibiotics9030131Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical PracticeChristina Scharf0Michael Paal1Ines Schroeder2Michael Vogeser3Rika Draenert4Michael Irlbeck5Michael Zoller6Uwe Liebchen7Department of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyInstitute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyInstitute of Laboratory Medicine, University Hospital, LMU Munich, 81377 Munich, GermanySection Clinical Infectious Diseases, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, GermanyVarious studies have reported insufficient beta-lactam concentrations in critically ill patients. The extent to which therapeutic drug monitoring (TDM) in clinical practice can reduce insufficient antibiotic concentrations is an ongoing matter of investigation. We retrospectively evaluated routine meropenem and piperacillin measurements in critically ill patients who received antibiotics as short infusions in the first year after initiating a beta-lactam TDM program. Total trough concentrations above 8.0 mg/L for meropenem and above 22.5 mg/L for piperacillin were defined as the breakpoints for target attainment. We included 1832 meropenem samples and 636 piperacillin samples. We found that 39.3% of meropenem and 33.6% of piperacillin samples did not reach the target concentrations. We observed a clear correlation between renal function and antibiotic concentration (meropenem, <i>r</i> = 0.53; piperacillin, <i>r</i> = 0.63). Patients with renal replacement therapy or creatinine clearance (CrCl) of <70 mL/min had high rates of target attainment with the standard dosing regimens. There was a low number of patients with a CrCl >100 mL/min that achieved the target concentrations with the maximum recommended dosage. Patients with impaired renal function only required TDM if toxic side effects were noted. In contrast, patients with normal renal function required different dosage regimens and TDM-guided therapy to reach the breakpoints of target attainment.https://www.mdpi.com/2079-6382/9/3/131meropenempiperacillintherapeutic drug monitoring (tdm)critical illnessrenal functionpharmacokineticexperience |
| spellingShingle | Christina Scharf Michael Paal Ines Schroeder Michael Vogeser Rika Draenert Michael Irlbeck Michael Zoller Uwe Liebchen Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice Antibiotics meropenem piperacillin therapeutic drug monitoring (tdm) critical illness renal function pharmacokinetic experience |
| title | Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice |
| title_full | Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice |
| title_fullStr | Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice |
| title_full_unstemmed | Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice |
| title_short | Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice |
| title_sort | therapeutic drug monitoring of meropenem and piperacillin in critical illness experience and recommendations from one year in routine clinical practice |
| topic | meropenem piperacillin therapeutic drug monitoring (tdm) critical illness renal function pharmacokinetic experience |
| url | https://www.mdpi.com/2079-6382/9/3/131 |
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