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
{"title":"Meropenem plasma concentrations in critically ill patients treated with the novel multi organ replacement therapy ADVOS.","authors":"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","doi":"10.1007/s15010-025-02554-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s15010-025-02554-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
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.
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.