Polain Amandine, Gorham Julie, Romeo Immacolata, Belliato Mirko, Peluso Lorenzo, Partipilo Francesco, Njimi Hassane, Brasseur Alexandre, Jacobs Frederique, Creteur Jacques, Hites Maya, Taccone Fabio Silvio
Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium.
UOC Anestesia e Rianimazione 2 Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Microorganisms. 2021 Oct 25;9(11):2219. doi: 10.3390/microorganisms9112219.
The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO).
Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (C) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if C was below the clinical breakpoint of Pseudomonas aeruginosa.
A total of 222 C (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 C 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.
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.
本研究的目的是确定接受体外膜肺氧合（ECMO）治疗的患者中β-内酰胺浓度不足的预测因素。
对所有接受ECMO支持并接受头孢他啶或头孢吡肟（CEF）、哌拉西林/他唑巴坦（TZP）或美罗培南（MEM）治疗的患者进行回顾性分析。根据主治医师的决定，在下次给药前测量血药谷浓度（C）。如果C低于铜绿假单胞菌的临床断点，则确定为药物浓度不足。
纳入了110例患者的222次血药浓度测量（CEF，n = 41；TZP，n = 85；MEM，n = 96）；在26次（12%）抗生素评估中观察到浓度不足；其中21次（81%）发生在MEM治疗期间。与其他患者相比，血药浓度不足与从开始使用抗生素到测量的时间较短、单次抗生素剂量较低、肌酐清除率（CrCL）较高、序贯器官衰竭评估（SOFA）评分较低以及连续肾脏替代治疗（CRRT）使用较少有关。
在ECMO治疗期间，12%的药物测量中观察到广谱β-内酰胺浓度不足。在治疗的极早期以及肾清除率增加且器官功能障碍较轻的患者中，可考虑使用高于推荐的药物方案。
