Int J Clin Pharmacol Ther. 2024 Jan;62(1):1-7. doi: 10.5414/CP204412.
Failure to achieve target concentrations of β-lactam antibiotics is not uncommon despite administration of high doses. The objective of this study was to identify risk factors predicting non-attainment of β-lactams target concentration in critically ill patients receiving meropenem as an intravenous infusion.
The retrospective study included adult patients receiving meropenem by intravenous infusion and undergoing therapeutic drug monitoring (TDM) in the intensive care units (ICU) at Nanjing First Hospital. Blood samples were analyzed using UPLC-MS. Potential risk factors were evaluated by correlating them with meropenem trough concentrations (C) lower than the targeted concentration (the minimum inhibitory concentration (MIC)).
Non-attainment of target concentrations was observed in 41 patients (19.5%) of the 210 patients examined. Predictors for non-attainment using multivariate logistic regression analysis were: age (p = 0.013), dosage (p = 0.042), augmented renal clearance (ARC), (p = 0.041).
In addition to the expected risk factors (age and dosage), ARC was a predictor for non-attainment of the target concentration. The risk of non-attainment of target concentrations increased with an increase in creatinine clearance. Attention should be given to ARC and creatinine clearance when administering meropenem by intravenous infusion.
尽管给予了高剂量，但β-内酰胺类抗生素仍未能达到目标浓度的情况并不少见。本研究的目的是确定预测重症患者接受美罗培南静脉输注时未能达到β-内酰胺类药物目标浓度的危险因素。
本回顾性研究纳入了在南京第一医院重症监护病房（ICU）接受美罗培南静脉输注并进行治疗药物监测（TDM）的成年患者。采用 UPLC-MS 分析血样。通过将潜在危险因素与低于目标浓度（最低抑菌浓度（MIC））的美罗培南谷浓度（C）相关联来评估其相关性。
在 210 例接受检查的患者中，有 41 例（19.5%）未达到目标浓度。多变量逻辑回归分析的非目标浓度预测因素为：年龄（p=0.013）、剂量（p=0.042）、代偿性肾清除率（ARC）（p=0.041）。
除了预期的危险因素（年龄和剂量）外，ARC 也是未达到目标浓度的预测因素。随着肌酐清除率的增加，未达到目标浓度的风险增加。在静脉输注美罗培南时，应注意 ARC 和肌酐清除率。
