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Updated: Jan 15, 2026
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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Variability in Antibiotic Dosing and Resistance Development during Continuous Renal Replacement Therapy in Critically
Danica Quickfall1, Ashley La2, Elizabeth Bell3
1Mayo Clinic, Department of Critical Care Medicine, Phoenix, Arizona, USA, quickfall.danica@mayo.edu.
Blood Purification
|January 13, 2026
Summary
Optimizing antibiotic dosing for critically ill patients on continuous renal replacement therapy (CRRT) is crucial. Suboptimal antibiotic doses during CRRT were linked to increased resistance in exploratory analyses.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Nephrology
Background:
- Antibiotic dosing in critically ill patients undergoing continuous renal replacement therapy (CRRT) presents significant challenges.
- Altered pharmacokinetics, CRRT variability, and limited guidance necessitate optimized dosing to prevent antibiotic resistance and toxicity.
Purpose of the Study:
- To evaluate antibiotic dosing strategies in intensive care unit (ICU) patients receiving CRRT.
- To investigate the association between CRRT parameters, antibiotic dosing, and the development of antimicrobial resistance.
Main Methods:
- Retrospective single-center study of ICU patients receiving CRRT and cefepime, meropenem, or piperacillin-tazobactam.
- Analysis of delivered CRRT dose, daily antibiotic doses, and resistance development in Pseudomonas aeruginosa and Enterobacter cloacae.
Main Results:
- Most patients received CRRT doses higher than recommended by KDIGO guidelines.
- Lower daily antibiotic doses during CRRT were independently associated with increased cefepime and meropenem resistance.
- Treatment-emergent resistance was observed in P. aeruginosa and E. cloacae.
Conclusions:
- Antibiotic doses administered during CRRT were often below therapeutic ranges.
- Findings suggest CRRT-informed dosing strategies may be important for managing antibiotic resistance.
- Balancing antibiotic efficacy and toxicity is essential in CRRT patients.
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