Department of Intensive Care. Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Department of Infectious Diseases. Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Am J Transplant. 2021 Jul;21(7):2489-2497. doi: 10.1111/ajt.16432. Epub 2020 Dec 25.
Antibiotic underdosing in prophylactic antibiotic regimes after lung transplantation (LTx) can increase the risk of infection. We aimed to study whether β-lactam concentrations achieved desirable pharmacodynamic targets in the early phase after LTx and the association between drug concentrations and the development of early infections or the acquisition of multidrug-resistant (MDR) strains. We reviewed patients in whom broad-spectrum β-lactam levels were measured after LTx during antibiotic prophylaxis. β-Lactam concentrations were considered "insufficient" if drug levels remained below four times the clinical breakpoint of the minimal inhibitory concentration for Pseudomonas aeruginosa. The primary outcome was the occurrence of an infection and/or acquisition of MDR pathogens in the first 14 days after transplantation. A total of 70 patients were included. "Insufficient" drug concentrations were found in 40% of patients. In 27% of patients, an early MDR pathogen was identified and 49% patients were diagnosed with an early posttransplant infection. Patients with "insufficient" drug concentrations acquired more frequently MDR bacteria and/or developed an infection than others (22/28, 79% vs. 20/42, 48% - p = .01). β-Lactam levels were often found to be below the desired drug targets in the early phase after transplantation and may be associated with the occurrence of early infectious complications.
预防性抗生素方案在肺移植（LTx）后抗生素剂量不足会增加感染风险。我们旨在研究在 LTx 后早期β-内酰胺类药物浓度是否达到理想的药效学目标，以及药物浓度与早期感染的发生或获得多重耐药（MDR）菌株之间的关系。我们回顾了在 LTx 期间接受抗生素预防治疗的广谱β-内酰胺类药物水平测定的患者。如果药物水平仍低于铜绿假单胞菌最小抑菌浓度的临床折点的 4 倍，则认为β-内酰胺类药物浓度“不足”。主要结局是在移植后 14 天内发生感染和/或获得 MDR 病原体。共纳入 70 例患者。40%的患者存在药物浓度不足。在 27%的患者中，早期发现了 MDR 病原体，49%的患者诊断为移植后早期感染。药物浓度不足的患者比其他患者更频繁地获得 MDR 细菌和/或发生感染（22/28，79%比 20/42，48%-p=0.01）。β-内酰胺类药物水平在移植后早期通常低于理想的药物靶标，可能与早期感染并发症的发生有关。
