Masich Anne M, Heavner Mojdeh S, Gonzales Jeffrey P, Claeys Kimberly C
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Curr Infect Dis Rep. 2018 Apr 4;20(5):9. doi: 10.1007/s11908-018-0613-1.
Beta-lactam antibiotics are commonly prescribed in critically ill patients for a variety of infectious conditions. Our understanding of how critical illness alters beta-lactam pharmacokinetics/pharmacodynamics (PK/PD) is rapidly evolving.
There is a growing body of literature in adult patients demonstrating that physiological alterations occurring in critically ill patients may limit our ability to optimally dose beta-lactam antibiotics to reach these PK/PD targets. These alterations include changes in volume of distribution and renal clearance with multiple, often overlapping causative pathways, including hypoalbuminemia, renal replacement therapy, and extracorporeal membrane oxygenation. Strategies to overcome these PK alterations include extended infusions and therapeutic drug monitoring. Combined data has demonstrated a possible survival benefit associated with extending beta-lactam infusions in critically ill adult patients. This review highlights research on physiological derangements affecting beta-lactam concentrations and strategies to optimize beta-lactam PK/PD in critically ill adults.
β-内酰胺类抗生素常用于重症患者治疗各种感染性疾病。我们对危重病如何改变β-内酰胺类药物的药代动力学/药效学（PK/PD）的理解正在迅速发展。
越来越多针对成年患者的文献表明，重症患者发生的生理改变可能会限制我们将β-内酰胺类抗生素剂量优化至达到这些PK/PD目标的能力。这些改变包括分布容积和肾脏清除率的变化，其有多种往往相互重叠的致病途径，包括低白蛋白血症、肾脏替代治疗和体外膜肺氧合。克服这些PK改变的策略包括延长输注时间和治疗药物监测。综合数据表明，在重症成年患者中延长β-内酰胺类药物输注时间可能具有生存获益。本综述重点介绍了影响β-内酰胺类药物浓度的生理紊乱研究以及优化重症成年患者β-内酰胺类药物PK/PD的策略。
