1Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia. 2Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 3Department of Pharmacy, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Crit Care Med. 2014 Jul;42(7):1640-50. doi: 10.1097/CCM.0000000000000317.
To describe the effect of different renal replacement therapy modalities and settings on the clearance of meropenem, piperacillin, and vancomycin in critically ill patients and to evaluate the frequency with which current dosing regimens achieve therapeutic concentrations.
Regression analyses of published pharmacokinetic data.
Pubmed was searched for relevant articles published between 1952 and 2013.
Original research articles describing the pharmacokinetics of meropenem, piperacillin, and vancomycin in critically ill patients receiving renal replacement therapy.
None.
Data from 30 studies were analyzed. The mean age of the patient groups involved in studies of meropenem, piperacillin, and vancomycin were 55.3, 60.3, and 56.9 years, respectively. The mean blood and effluent flow rates used for each antibiotic were 151.3 and 33.8 mL/min, 131.8 and 27.3 mL/min, and 189.3 and 35.6 mL/min, respectively, in continuous renal replacement therapy studies. Correlations existed between effluent flow rate in continuous renal replacement therapy and extracorporeal clearance for meropenem (rs = 0.43; p = 0.12), piperacillin (rs = 0.77; p = 0.10), and vancomycin (rs = 0.90; p = 0.08). Current dosing regimens achieved target concentrations for meropenem (89%), piperacillin (83%), and vancomycin (60%) against susceptible pathogens.
Effluent flow rate appears to be a reliable predictor of antibiotic clearance in critically ill patients despite significantly altered pharmacokinetics in these patients. Higher dosing regimens maybe required in critically ill patients receiving renal replacement therapy, in the presence of high effluent flow rates and/or the presence of poorly susceptible pathogens, particularly for vancomycin.
描述不同肾脏替代治疗方式和设置对重症患者中美罗培南、哌拉西林和万古霉素清除率的影响，并评估当前给药方案达到治疗浓度的频率。
对已发表的药代动力学数据进行回归分析。
在 Pubmed 上搜索了 1952 年至 2013 年期间发表的相关文章。
描述接受肾脏替代治疗的重症患者中美罗培南、哌拉西林和万古霉素药代动力学的原始研究文章。
无。
对 30 项研究的数据进行了分析。参与美罗培南、哌拉西林和万古霉素研究的患者组的平均年龄分别为 55.3、60.3 和 56.9 岁。连续肾脏替代治疗研究中，每种抗生素的平均血液和流出液流速分别为 151.3 和 33.8mL/min、131.8 和 27.3mL/min、189.3 和 35.6mL/min。连续肾脏替代治疗中的流出液流速与美罗培南（rs=0.43；p=0.12）、哌拉西林（rs=0.77；p=0.10）和万古霉素（rs=0.90；p=0.08）的体外清除率之间存在相关性。目前的给药方案使美罗培南（89%）、哌拉西林（83%）和万古霉素（60%）针对敏感病原体达到了目标浓度。
尽管这些患者的药代动力学发生了显著改变，但流出液流速似乎是重症患者中抗生素清除率的可靠预测指标。在存在高流出液流速和/或存在敏感性较差的病原体的情况下，接受肾脏替代治疗的重症患者可能需要更高的给药方案，尤其是万古霉素。
