Related Experiment Video

Updated: Jun 5, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

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Beta-Lactam Antibiotic Exposure During Pediatric Extracorporeal Membrane Oxygenation: Retrospective Cohort Analysis

Alice Marsaux1, Pierre-Louis Léger2, Jérôme Rambaud2

  • 1Service de Réanimation et surveillance continue médicochirurgicales, Hôpital Necker Enfants-Malades, AP-HP, Université Paris Cité, Paris, France.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 4, 2024
PubMed

Insights

Standard beta-lactam antibiotic dosing in children on extracorporeal membrane oxygenation (ECMO) frequently leads to inadequate drug levels, increasing infection risk. Dosing adjustments are crucial for optimizing treatment in this vulnerable pediatric population.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology and Therapeutics
  • Infectious Diseases

Background:

  • Children on extracorporeal membrane oxygenation (ECMO) face a high risk of infections, impacting prognosis.
  • Standard beta-lactam antibiotic dosing may not account for altered pharmacokinetics in pediatric ECMO patients, risking inadequate drug exposure.

Purpose of the Study:

  • To evaluate beta-lactam antibiotic exposure levels in pediatric ECMO patients receiving current dosing regimens.
  • To identify factors associated with inadequate or supratherapeutic beta-lactam concentrations in this population.

Main Methods:

  • Retrospective cohort study involving pediatric intensive care units (PICUs).
  • Analysis of 226 plasma beta-lactam concentrations from 57 children (neonates to 18 years) on ECMO between 2018 and 2020.
  • Assessment against a pharmacokinetic/pharmacodynamic target of four times the minimum inhibitory concentration throughout the dosing interval.

Main Results:

  • Over half (58.8%) of analyzed beta-lactam concentrations were insufficient, particularly in neonates, low-weight patients, and those with hypoalbuminemia or increased renal clearance.
  • Supratherapeutic concentrations (11.1%) were linked to renal impairment.
  • 32 infections were documented among the study cohort.

Conclusions:

  • Conventional beta-lactam dosing in pediatric ECMO patients carries a significant risk of underexposure, often linked to renal impairment and fluid overload.
  • Therapeutic drug monitoring and pharmacokinetic/pharmacodynamic modeling should be prospectively evaluated to mitigate risks in this high-risk group.
Abstract

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