1. An evaluation of risk factors to predict target concentration non-attainment in critically ill patients prior to empiric β-lactam therapy
- Author
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Richard O. Day, Sheridan Gentili, Deborah Marriott, Hergen Buscher, Indy Sandaradura, Ross Norris, Sahand Imani, Graham R D Jones, Imani, Sahand, Buscher, Hergen, Day, Richard, Gentili, Sheridan, Jones, Graham RD, Marriott, Debbie, Norris, Ross, and Sandaradura, Indy
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,target concentration non-attainment ,medicine.drug_class ,Critical Illness ,therapeutic drug monitoring ,critically ill ,medicine.medical_treatment ,030106 microbiology ,Antibiotics ,Renal function ,Microbial Sensitivity Tests ,beta-Lactams ,Meropenem ,03 medical and health sciences ,Cmin ,0302 clinical medicine ,Risk Factors ,Tandem Mass Spectrometry ,β-lactam antibiotics ,Internal medicine ,Odds Ratio ,medicine ,Humans ,risk factors ,Renal replacement therapy ,Chromatography, High Pressure Liquid ,Aged ,medicine.diagnostic_test ,business.industry ,beta-lactam antibiotics ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,Anti-Bacterial Agents ,Intensive Care Units ,Infectious Diseases ,empiric prescribing ,Therapeutic drug monitoring ,Cohort ,Female ,business ,Biomarkers ,Piperacillin ,medicine.drug - Abstract
To determine whether target concentration non-attainment can be anticipated in critically ill patients prior to initiating empiric β-lactam antibiotic therapy based on readily available clinical factors. Retrospective review of consecutive patients treated with piperacillin or meropenem and who underwent therapeutic drug monitoring (TDM) at St Vincent’s Hospital (Sydney, Australia)between January 2013 and December 2015 was performed. Predefined subgroups were patients who received continuous renal replacement therapy (CRRT) and those who did not (non-CRRT). Potential risk factors were evaluated by correlation with β-lactam antibiotic trough concentrations (Cₘᵢₙ) lower than or equal to targeted minimum inhibitory concentration (MIC). Only the first drug concentration after initiation of the antibiotic treatment was included to reflect empirical dose selection. A total of n =249 patients (piperacillin, n = 169; meropenem, n = 80) were investigated. For non-CRRT patients (n = 210), multivariate analysis demonstrated the following: male gender (p = 0.006); younger age (p = 0.015); prescribed daily antibiotic dose less than 1.5 times the product information recommendations (p = 0.004); lack of positive microbiology (p = 0.006); lower overall illness severity (p = 0.005); and estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2 (p < 0.001), to be associated with Cₘᵢₙ ≤ MIC. No predictor variable was found to be significantly associated with Cₘᵢₙ ≤ MIC for the CRRT cohort. Evaluating the risk of target concentration non-attainment using simple clinical factors is possible at the bedside for non-CRRT patients prior to empiric antibiotic initiation. Clinicians should be wary of selecting doses based on the product information especially when treating younger male patients with apparently ‘normal’ renal function. Refereed/Peer-reviewed
- Published
- 2018