Decreased meropenem levels in Intensive Care Unit patients with augmented renal clearance: benefit of therapeutic drug monitoring

Tröger, Uwe; Drust, Andreas; Martens‐Lobenhoffer, Jens; Tanev, Ivan; Braun-Dullaeus, Ruediger C.; Bode‐Böger, Stefanie M.

doi:10.1016/j.ijantimicag.2012.05.010

Cited by 65 publications

(49 citation statements)

References 21 publications

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“…Timely recognition of sepsis and the administration of an appropriate antimicrobial agent (with a suitable spectrum of cover) remains the cornerstone of effective management [2], but what is more uncertain is the impact of variable antibacterial exposure, beyond simple susceptibility patterns. In this fashion, the host response as well as ancillary interventions provided can have marked effects on the pharmacokinetics of these agents, leading to highly variable drug concentrations following standard dosing [3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

mentioning

confidence: 99%

Augmented renal clearance and therapeutic monitoring of β-lactams

Udy¹,

Waele²,

Lipman³

2015

International Journal of Antimicrobial Agents

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mentioning

confidence: 99%

Augmented renal clearance and therapeutic monitoring of β-lactams

Udy¹,

Waele²,

Lipman³

2015

International Journal of Antimicrobial Agents

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“…Furthermore, patients, presenting dysfunction in vital organs such as kidney and liver that represent the major routes for drug elimination, are at increased risk of the prompt onset of toxic drug concentration [12,23]. On the other hand, patients with augmented renal clearance [24] or prescribed with continuous renal therapy suffer from decreased levels of antibiotics necessary to achieve a positive clinical outcome [25]. It is evident that different antibiotics are differently affected by the pathophysiological changes encountered in ICU patients.…”

Section: Impact Of Pathophysiological Changes On the Antimicrobial Thmentioning

confidence: 99%

The use of liquid chromatography-tandem mass spectrometry for therapeutic drug monitoring of antibiotics in cancer patients

El‐Najjar

Gessner

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Cancer remains a leading cause of mortality and morbidity worldwide. In addition to organ failure, the most frequent reasons for admission of cancer patients to intensive care units (ICU) are: infections and sepsis. As critically ill, the complexity of the health situation of cancer patients renders the standard antimicrobial regimen more complex and even inadequate which results in increased mortality rates. This is due to pathophysiological changes in the volume of distribution, increased clearance, as well as to organ dysfunction. While in the former cases a decrease in drug efficacy is observed, the hallmark of the latter one is overdosing leading to increased toxicity at the expense of efficacy. Furthermore, an additional risk factor is the potential drug-drug interaction between antibiotics and antineoplastic agents. Therefore, therapeutic drug monitoring (TDM) is a necessity to improve the clinical outcome of antimicrobial therapy in cancer patients. To be applied in routine analysis the method used for TDM should be cheap, fast and highly accurate/sensitive. Furthermore, as ICU patients are treated with a cocktail of antibiotics the method has to cover the simultaneous analysis of antibiotics used as a first/second line of treatment. The aim of the current review is to briefly survey the pitfalls in the current antimicrobial therapy and the central role of TDM in dose adjustment and drug-drug interaction's evaluation. A major section is dedicated to summarize the currently published analytical methods and to shed light on the difficulties and potential problems that can be encountered during method development.

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“…Therapeutic drug monitoring (TDM) is discussed as a key intervention to improve outcomes in patients with sepsis and septic shock. In these patients, pharmacokinetics of ß-lactam antibiotics may be altered due to dynamic, unpredictable pathophysiological changes and significant increases in the volume of distribution and/or augmented renal (drug) clearance (ARC) (43,44,45). When ß-lactam antibiotics are applied uncontrolled, pharmacokinetic changes can result in sub-therapeutic plasma concentrations, treatment failure, and the development of antibiotic resistance.…”

Section: Shortfalls In the Detection Of Antibiotic Resistancesmentioning

confidence: 99%

Sepsis biomarkers and pathogen detection methods: State of the art

Roland¹,

M²

2014

SANAMED

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Abstract:Evidence-based blood culture testing is of utmost importance for ICU patients with suspected sepsis or organ infection. Knowledge of the etiologic agent (bacteria or fungi) and their susceptibility against antimicrobials enables the clinician to initiate an appropriate antimicrobial therapy and guides diagnostic procedures. This has been shown to reduce mortality, ICU--stay and antibiotic overuse. Whereas microbiological laboratory practice has been highly standardized, shortfalls in the preanalytic procedures in the ICU (indication, timing, volume, numbers, collection of blood cultures) have a significant effect on the diagnostic yield.Due to system-related drawbacks of molecular diagnostics, i.e. PCR-based pathogen detection, which are arguable sensitivities, the failing of the 'fast time-to-result argument', no solution to establish a comprising antibiogram, still ongoing discussions on the coverage of the target panel, high overall costs, and the lacking of resilient data on clinical utility, non-culture-based NATs do currently not represent an alternative to blood culture testing.Inflammatory markers are recognized to play an increasingly important role in the diagnosis and monitoring of sepsis. This is partly due to low specificity of clinical symptoms and conventional inflammatory signs for the diagnosis of sepsis but also to a lack of correlation with the severity of the inflammatory response. Elevated serum PCT levels indicate systemic inflammation reliably. PCT is the only sepsis marker that is helpful in the differentiation between infectious and non-infectious causes of organ dysfunction and shock and might support antibiotic therapy.

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Decreased meropenem levels in Intensive Care Unit patients with augmented renal clearance: benefit of therapeutic drug monitoring

Cited by 65 publications

References 21 publications

Augmented renal clearance and therapeutic monitoring of β-lactams

Augmented renal clearance and therapeutic monitoring of β-lactams

The use of liquid chromatography-tandem mass spectrometry for therapeutic drug monitoring of antibiotics in cancer patients

Sepsis biomarkers and pathogen detection methods: State of the art

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