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Early target attainment of continuous infusion piperacillin/tazobactam and meropenem in critically ill patients: A

Sofie A M Dhaese1, Alexander D J Thooft2, Andras Farkas3

  • 1Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.

Journal of Critical Care
|April 16, 2019
PubMed
Abstract

Insights

Target attainment for piperacillin/tazobactam (TZP) was low (37%) and for meropenem (MER) moderate (75%) in critically ill patients. Creatinine clearance impacted attainment, with MER showing better results than TZP.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Optimizing antibiotic dosing in critically ill patients is crucial for effective treatment and combating antimicrobial resistance.
  • Continuous infusion strategies are employed to improve pharmacokinetic/pharmacodynamic targets for beta-lactam antibiotics.
  • Piperacillin/tazobactam (TZP) and meropenem (MER) are commonly used broad-spectrum antibiotics in intensive care settings.

Purpose of the Study:

  • To evaluate the target attainment of empirically dosed continuous infusion piperacillin/tazobactam (TZP) and meropenem (MER) in critically ill patients.
  • To identify factors associated with achieving therapeutic drug concentrations for these antibiotics.

Main Methods:

  • Prospective study involving 253 critically ill patients receiving either TZP or MER via continuous infusion.
  • Antibiotic concentrations were measured daily during the first two days of therapy.
  • Target concentrations were defined based on unbound drug levels relative to the P. aeruginosa epidemiological cutoff value and toxicity thresholds.

Main Results:

  • Overall target attainment was 37.1% for TZP (76/205) and 75% for MER (36/48).
  • Estimated creatinine clearance was a significant risk factor for target non-attainment (OR 0.988).
  • Patients receiving MER were significantly more likely to achieve target concentrations compared to those on TZP (OR 6.02).

Conclusions:

  • Empirical antibiotic therapy with continuous infusion TZP showed low target attainment (37%) in critically ill patients.
  • Continuous infusion MER demonstrated moderate target attainment (75%), outperforming TZP.
  • Despite optimized infusion strategies, achieving target antibiotic concentrations remains a challenge in this population, highlighting the need for individualized dosing adjustments.
Keywords:
Continuous infusionCritically ill patientsEmpirical therapyMeropenemPiperacillinTarget attainment

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