Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients.

Amandine Polain,Lorenzo Peluso,Julie Gorham,Fabio Silvio Taccone,Hassane Njimi,Jacques Creteur,Mirko Belliato,Francesco Partipilo,Frederique Jacobs,Alexandre Brasseur,Maya Hites,Immacolata Romeo

doi:10.3390/microorganisms9112219

Abstract

Background: The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Methods: Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (Cmin) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if Cmin was below the clinical breakpoint of Pseudomonas aeruginosa. Results: A total of 222 Cmin (CEF, n = 41; TZP, n = 85; MEM, n = 96) from 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient Cmin were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. Conclusions: Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction.

Highlights

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy providing a temporary cardiac and/or pulmonary life support while treating the underlying cause of cardiac and/or respiratory failure
Over a total of 564 extracorporeal membrane oxygenation (ECMO) patients treated over the study period, 454 patients were excluded (n = 97 did not receive antibiotics; n = 297 did not receive the studied drugs; 170 in whom therapeutic drug monitoring (TDM) was not performed)
The limited number of events and the presence of repeated meas-. In this retrospective study including the largest cohort of ECMO patients undergoing TDM of beta-lactam antibiotics, we observed insufficient drug levels only in 12% of measurements, in particular for MEM

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy providing a temporary cardiac and/or pulmonary life support while treating the underlying cause of cardiac and/or respiratory failure. The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Insufficient drug concentrations were identified if Cmin was below the clinical breakpoint of Pseudomonas aeruginosa. From 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient Cmin were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. Conclusions: Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction

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