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Elevated β-lactam concentrations associated with neurological deterioration in ICU septic patients

M Beumier1, G S Casu, M Hites

  • 1Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium - ftaccone@ulb.ac.be.

Minerva Anestesiologica
|September 16, 2014
PubMed
Abstract

Insights

High beta-lactam antibiotic concentrations in septic ICU patients correlate with neurological deterioration. Monitoring drug levels may help identify causes of worsening neurological status during critical illness.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Neuroscience

Background:

  • Beta-lactam antibiotics are generally safe but can cause neurotoxicity.
  • Septic ICU patients may experience neurological alterations.
  • Assessing the link between beta-lactam levels and neurotoxicity is crucial.

Purpose of the Study:

  • To evaluate the association between beta-lactam concentrations and neurological changes in septic ICU patients.
  • To determine if high drug trough concentrations predict neurological worsening.

Main Methods:

  • Retrospective study of ICU patients treated with meropenem, piperacillin-tazobactam, or ceftazidime/cefepime.
  • Measured beta-lactam trough concentrations (C min) and normalized to MIC (C min/MIC).
  • Assessed neurological status using the change in neurological SOFA score (ΔnSOFA).

Main Results:

  • No difference in neurological worsening (NWS) across antibiotic groups.
  • NWS occurrence increased with higher C min/MIC ranges (P=0.008).
  • C min/MIC was an independent predictor of NWS (OR 1.12).

Conclusions:

  • High beta-lactam trough concentrations correlate with neurological deterioration in septic ICU patients.
  • Causality cannot be determined, but monitoring is recommended.
  • Consider monitoring beta-lactam levels in critically ill patients with neurological decline.

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