Abstract
Studies have shown significant variability in antibiotic trough concentrations in critically ill patients receiving renal replacement therapy (RRT). The purpose of this study was to assess whether adding beta-lactam antibiotics to dialysate solution can maintain stable antibiotic concentrations during RRT in experimental conditions. A single compartment model reflecting the patient was constructed and connected to the RRT machine. Dialysate fluid was prepared in three different concentrations of meropenem (0 mg/L; 16 mg/L; 64 mg/L). For each dialysate concentration various combinations of dialysate and blood flow rates were tested by taking different samples. Meropenem concentration in all samples was calculated using spectrophotometry method. Constructed experimental model results suggest that decrease in blood meropenem concentration can be up to 35.6%. Moreover, experimental data showed that antibiotic loss during RRT can be minimized and stable plasma antibiotic concentration can be achieved with the use of a 16 mg/L Meropenem dialysate solution. Furthermore, increasing meropenem concentration up to 64 mg/L is associated with an increase antibiotic concentration up to 18.7–78.8%. Administration of antibiotics to dialysate solutions may be an effective method of ensuring a constant concentration of antibiotics in the blood of critically ill patients receiving RRT.
Highlights
Studies have shown significant variability in antibiotic trough concentrations in critically ill patients receiving renal replacement therapy (RRT)
The results of this experimental study confirm the hypothesis that adding beta-lactam antibiotics to dialysate solution can maintain stable antibiotic concentrations during RRT
To our knowledge this is the first experimental study describing the antibiotic administration to dialysate in CRRT
Summary
Studies have shown significant variability in antibiotic trough concentrations in critically ill patients receiving renal replacement therapy (RRT). The cause of AKI is often multifactorial; sepsis, septic shock and concomitant systemic inflammatory response syndrome are the most common causes of AKI in the critically ill, accounting for over 60% of cases[9,10,11,12,13] Mortality in this subgroup of patients is considerably higher, reaching up to 50%13. Studies have shown that there is a significant variability in antibiotic trough concentrations in critically ill patients receiving RRT, revealing that empirical dosing failed to achieve the target in 25–60% of patients receiving continuous RRT14–16 This unintended under-dosing leads to increased resistance of the microflora and sub-optimal effect, prolonged hospitalization and worse clinical o utcome[17,18,19]. The aim of the study was to assess whether adding beta-lactam antibiotics to dialysate solution can maintain stable antibiotic concentrations during CRRT in experimental conditions
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