β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study

Donadello, Katia, Antonucci, Elio, Cristallini, Stefano, Roberts, Jason A., Beumier, Marjorie, Scolletta, Sabino, Jacobs, Frederique, Rondelet, Benoit, de Backer, Daniel, Vincent, Jean-Louis and Taccone, Fabio Silvio (2015) β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study. International Journal of Antimicrobial Agents, 45 3: 278-282. doi:10.1016/j.ijantimicag.2014.11.005


Author Donadello, Katia
Antonucci, Elio
Cristallini, Stefano
Roberts, Jason A.
Beumier, Marjorie
Scolletta, Sabino
Jacobs, Frederique
Rondelet, Benoit
de Backer, Daniel
Vincent, Jean-Louis
Taccone, Fabio Silvio
Title β-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 1872-7913
0924-8579
Publication date 2015-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2014.11.005
Open Access Status Not yet assessed
Volume 45
Issue 3
Start page 278
End page 282
Total pages 5
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
2736 Pharmacology (medical)
Abstract Most adult patients receiving extracorporeal membrane oxygenation (ECMO) require antibiotic therapy, however the pharmacokinetics of β-lactams have not been well studied in these conditions. In this study, data from all patients receiving ECMO support and meropenem (MEM) or piperacillin/tazobactam (TZP) were reviewed. Drug concentrations were measured 2 h after the start of a 30-min infusion and just before the subsequent dose. Therapeutic drug monitoring (TDM) results in ECMO patients were matched with those in non-ECMO patients for (i) drug regimen, (ii) renal function, (iii) total body weight, (iv) severity of organ dysfunction and (v) age. Drug concentrations were considered adequate if they remained 4-8× the clinical MIC breakpoint for Pseudomonas aeruginosa for 50% (TZP) or 40% (MEM) of the dosing interval. A total of 41 TDM results (27 MEM; 14 TZP) were obtained in 26 ECMO patients, with 41 matched controls. There were no significant differences in serum concentrations or pharmacokinetic parameters between ECMO and non-ECMO patients, including V [0.38 (0.27-0.68) vs. 0.46 (0.33-0.79) L/kg; P = 0.37], half-life [2.6 (1.8-4.4) vs. 2.9 (1.7-3.7) h; P = 0.96] and clearance [132 (66-200) vs. 141 (93-197) mL/min; P = 0.52]. The proportion of insufficient (13/41 vs. 12/41), adequate (15/41 vs. 19/41) and excessive (13/41 vs. 10/41) drug concentrations was similar in ECMO and non-ECMO patients. Achievement of target concentrations of these β-lactams was poor in ECMO and non-ECMO patients. The influence of ECMO on MEM and TZP pharmacokinetics does not appear to be significant.
Formatted abstract
Most adult patients receiving extracorporeal membrane oxygenation (ECMO) require antibiotic therapy, however the pharmacokinetics of β-lactams have not been well studied in these conditions. In this study, data from all patients receiving ECMO support and meropenem (MEM) or piperacillin/tazobactam (TZP) were reviewed. Drug concentrations were measured 2 h after the start of a 30-min infusion and just before the subsequent dose. Therapeutic drug monitoring (TDM) results in ECMO patients were matched with those in non-ECMO patients for (i) drug regimen, (ii) renal function, (iii) total body weight, (iv) severity of organ dysfunction and (v) age. Drug concentrations were considered adequate if they remained 4–8× the clinical MIC breakpoint for Pseudomonas aeruginosa for 50% (TZP) or 40% (MEM) of the dosing interval. A total of 41 TDM results (27 MEM; 14 TZP) were obtained in 26 ECMO patients, with 41 matched controls. There were no significant differences in serum concentrations or pharmacokinetic parameters between ECMO and non-ECMO patients, including Vd [0.38 (0.27–0.68) vs. 0.46 (0.33–0.79) L/kg; P = 0.37], half-life [2.6 (1.8–4.4) vs. 2.9 (1.7–3.7) h; P = 0.96] and clearance [132 (66–200) vs. 141 (93–197) mL/min; P = 0.52]. The proportion of insufficient (13/41 vs. 12/41), adequate (15/41 vs. 19/41) and excessive (13/41 vs. 10/41) drug concentrations was similar in ECMO and non-ECMO patients. Achievement of target concentrations of these β-lactams was poor in ECMO and non-ECMO patients. The influence of ECMO on MEM and TZP pharmacokinetics does not appear to be significant.
Keyword Antibiotic
Pharmacokinetics
Extracorporeal membrane oxygenation
ECMO
Sepsis
ICU
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID APP1048652
Institutional Status UQ
Additional Notes Published online ahead of print 8 Dec 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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