Fiaccadori Enrico, Maggiore Umberto, Rotelli Carlo, Giacosa Roberto, Parenti Elisabetta, Picetti Edoardo, Sagripanti Sibilla, Manini Paola, Andreoli Roberta, Cabassi Aderville
Dipartimento di Clinica Medica, Nefrologia, & Scienze della Prevenzione, Università degli Studi di Parma, Parma, Italy.
Crit Care Med. 2004 Dec;32(12):2437-42. doi: 10.1097/01.ccm.0000147687.06808.92.
To study the removal of linezolid, a new oxazolidinone antibiotic, by renal replacement therapy in patients with acute renal failure.
Prospective, single-dose pharmacokinetic study.
Renal intensive care unit of a tertiary university hospital.
Fifteen critically ill patients with oliguric acute renal failure on renal replacement therapy (seven males, mean age 72.3 yrs, range 60-94; Acute Physiology and Chronic Health Evaluation II score 24.9, range 18-36; mechanical ventilation ten of 15).
All patients received 600 mg of intravenous linezolid before starting renal replacement therapy, which consisted of intermittent hemodialysis lasting 3-4 hrs in eight patients, sustained low-efficiency dialysis lasting 8 hrs in five patients, and continuous venovenous hemofiltration lasting 10.5-12 hrs in two patients.
Linezolid concentrations were measured by liquid chromatography/mass spectrometry methods on serum and dialysate/ultrafiltrate samples. At the start of renal replacement therapy, serum levels averaged 11.91 mg/L (range 5.49-21.52) and dropped at the end to levels <4 mg/dL (90% minimum inhibitory concentration values for Staphylococcus aureus) in three of eight patients on hemodialysis, three of five patients on sustained low-efficiency dialysis, and two of two patients on continuous venovenous hemofiltration. Mean removal of the drug was 193.7 mg with hemodialysis (32.3% of the dose administered), 205 mg with sustained low-efficiency dialysis (33.9%), and 74.8 mg (12.4%) and 105 (17.5%) mg following a continuous venovenous hemofiltration session lasting 10.5 and 12 hrs, respectively.
In patients with acute renal failure, serum levels of linezolid can be reduced to the subtherapeutic range following renal replacement therapy.
研究新型恶唑烷酮类抗生素利奈唑胺在急性肾衰竭患者中通过肾脏替代治疗的清除情况。
前瞻性单剂量药代动力学研究。
一所三级大学医院的肾脏重症监护病房。
15例接受肾脏替代治疗的少尿型急性肾衰竭重症患者（7例男性，平均年龄72.3岁，范围60 - 94岁；急性生理与慢性健康状况评分II为24.9，范围18 - 36；15例中有10例接受机械通气）。
所有患者在开始肾脏替代治疗前静脉给予600 mg利奈唑胺，其中8例患者接受持续3 - 4小时的间歇性血液透析，5例患者接受持续8小时的持续低效透析，2例患者接受持续10.5 - 12小时的连续性静脉 - 静脉血液滤过。
采用液相色谱/质谱法测定血清及透析液/超滤液样本中的利奈唑胺浓度。在肾脏替代治疗开始时，血清水平平均为11.91 mg/L（范围5.49 - 21.52），在接受血液透析的8例患者中有3例、接受持续低效透析的5例患者中有3例以及接受连续性静脉 - 静脉血液滤过的2例患者中有2例在治疗结束时血清水平降至<4 mg/dL（金黄色葡萄球菌的90%最低抑菌浓度值）。血液透析平均清除药物193.7 mg（占给药剂量的32.3%），持续低效透析清除205 mg（33.9%），持续10.5小时和12小时的连续性静脉 - 静脉血液滤过分别清除74.8 mg（12.4%）和105 mg（17.5%）。
在急性肾衰竭患者中，肾脏替代治疗后利奈唑胺的血清水平可降至亚治疗范围。
