Meropenem plasma concentrations in critically ill patients treated with the novel multi organ replacement therapy ADVOS.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-05-21 DOI:10.1007/s15010-025-02554-4

David Totschnig, Theresa Mader, Thomas Stimpfl, Klaus Breinbauer, Cristina Groza, David Stücklschwaiger, Stephanie Neuhold, Emanuela Friese, Johannes Holbik, Martina Delivuk, Tom Ripplinger, Marcell Leber, Clemens Ott, Wolfgang Hoepler, Aritz Perez Ruiz de Garibay, Christoph Wenisch, Otto Frey, Alexander Zoufaly, Marianna Traugott

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引用次数: 0

Abstract

Background: Optimal dosing of antibiotics in critically ill patients treated with the novel multi organ replacement therapy ADVOS (ADVanced Organ Support) based on albumin dialysis is unclear. This study aims to provide real life data on meropenem plasma concentrations after prolonged infusion in patients treated with ADVOS and a critically ill control group with and without continuous veno-venous hemodiafiltration (CVVHDF).

Methods: We retrospectively analyzed plasma concentrations of meropenem obtained as part of our standard of care therapeutic drug monitoring in the intensive care unit. Meropenem was administered as a prolonged infusion over 3 h. We measured peak and trough levels, pre-and post-filter levels of meropenem using high performance liquid chromatography. We calculated the meropenem clearance and compared the measured clearance with predicted clearance based on creatinine, calculated by the MeroEasy tool.

Results: In total, 159 measurements across 16 patients were analyzed. Meropenem trough concentrations were highest in the CVVHDF group with a median of 23.5 mg/L, followed by the ADVOS (median 9.3 mg/L) and control group (median 7.6 mg/L). No trough levels were below the lower limit of 2 mg/L in the CVVHDF and ADVOS groups. Meropenem machine clearance by CVVHDF was calculated to be 1.8 (± 0.5) L/h and 3.5 (± 1) L/h for ADVOS.

Conclusion: Our results suggest that ADVOS treatment in critically ill patients receiving a high dose meropenem regimen (2 g IV q8h) does not lead to underdosing. Some trough values were even within potentially toxic levels, especially in the CVVHDF group, highlighting the importance of therapeutic drug monitoring.

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新型多器官替代疗法ADVOS治疗危重患者美罗培南血药浓度变化。

背景：目前尚不清楚危重患者接受基于白蛋白透析的新型多器官替代疗法ADVOS（高级器官支持）治疗时抗生素的最佳剂量。本研究旨在提供长期输注美罗培南的真实生活数据，这些患者接受ADVOS治疗，重症对照组接受和不接受持续静脉-静脉血液滤过（CVVHDF）治疗。方法：我们回顾性分析重症监护病房治疗药物监测标准中获得的美罗培南血浆浓度。美罗培南长期输注超过3小时。我们使用高效液相色谱法测量了美罗培南的峰谷水平、过滤前和过滤后水平。我们计算美罗培南清除率，并将测量清除率与MeroEasy工具计算的基于肌酐的预测清除率进行比较。结果：共分析了16例患者的159个测量值。CVVHDF组美罗苯南谷浓度最高，中位数为23.5 mg/L，其次是ADVOS组（中位数为9.3 mg/L）和对照组（中位数为7.6 mg/L）。CVVHDF组和ADVOS组均未出现低于2 mg/L的谷值。CVVHDF计算美罗培南机器间隙为1.8（±0.5）L/h， ADVOS为3.5（±1）L/h。结论：我们的研究结果表明，在接受高剂量美罗培南方案（2g IV q8h）的危重患者中，ADVOS治疗不会导致剂量不足。一些波谷值甚至在潜在毒性水平内，特别是在CVVHDF组，突出了治疗药物监测的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.