Ceftaroline pharmacokinetics on ECMO, a pediatric case report.

Area of Science:

• Pharmacokinetics
• Critical Care Medicine
• Infectious Diseases

Background:

• Extracorporeal membrane oxygenation (ECMO) may reduce antibiotic efficacy due to drug sequestration.
• Limited data exist on ceftaroline concentrations in patients undergoing ECMO.
• Influenza-associated necrotizing pneumonia is a severe condition requiring advanced life support.

Purpose of the Study:

• To analyze ceftaroline pharmacokinetics in a pediatric patient on ECMO.
• To assess the impact of ECMO on ceftaroline drug exposure.
• To determine if therapeutic ceftaroline concentrations can be achieved during ECMO.

Main Methods:

• Case report of a 5-year-old patient on ECMO for influenza-associated necrotizing pneumonia.
• Analysis of 9 ceftaroline concentrations (3 pre-ECMO, 6 on ECMO).
• Pharmacokinetic parameter estimation (volume of distribution, clearance).

Main Results:

• ECMO initiation resulted in minor changes in ceftaroline volume of distribution (0.17 to 0.20 L/kg) and clearance (1.00 to 0.86 mL/min/kg).
• The patient maintained 100% time above the minimum inhibitory concentration (MIC) while on ECMO.
• No substantial ceftaroline adsorption or sequestration was observed in the Nautilus oxygenator circuit.

Conclusions:

• Therapeutic ceftaroline concentrations are achievable in patients supported by ECMO.
• Current ECMO oxygenators may not significantly sequester ceftaroline.
• Clinicians can consider continuing ceftaroline therapy in ECMO patients with favorable microbiologic responses.