Dillies Théo, Perinel-Ragey Sophie, Correia Patricia, Morel Jérôme, Thiery Guillaume, Launay Manon
Service de Médecine Intensive et Réanimation G, Centre Hospitalier Universitaire (CHU) deSaint-Etienne, F-42055 Saint Etienne, France.
SAINBIOSE U1059, Université Jean Monnet, INSERM, F-42023 Saint Etienne, France.
Antibiotics (Basel). 2024 Mar 29;13(4):313. doi: 10.3390/antibiotics13040313.
Cefotaxime administration is recommended in doses of 3-12 g/day in adults with a Glomerular Filtration Rate (GFR) > 5 mL/min. This study aimed to assess the impact of renal function and obesity on cefotaxime concentrations in intensive care unit (ICU) patients. A retrospective cohort study was conducted on consecutive ICU patients receiving continuous cefotaxime infusion between 2020 and 2022 [IRBN992021/CHUSTE]. Doses were not constant; consequently, a concentration-to-dose ratio (C/D) was considered. Statistical analysis was performed to assess the relationship between cefotaxime concentrations, renal function, and obesity. A total of 70 patients, median age 61 years, were included, with no significant difference in cefotaxime concentrations between obese and non-obese patients. However, concentrations varied significantly by GFR, with underdosing prevalent in patients with normal to increased renal function and overdosing in those with severely impaired renal function. Adjustment of cefotaxime dosing according to GFR was associated with improved target attainment. Cefotaxime dosing in critically ill patients should consider renal function, with higher initial doses required in patients with normal to increased GFR and lower doses in those with severely impaired renal function. Therapeutic drug monitoring may aid in optimising dosing regimens. Prospective studies are warranted to validate these findings and inform clinical practice.
对于肾小球滤过率（GFR）>5 mL/min的成人，推荐使用头孢噻肟，剂量为3 - 12 g/天。本研究旨在评估肾功能和肥胖对重症监护病房（ICU）患者头孢噻肟浓度的影响。对2020年至2022年期间连续接受头孢噻肟持续输注的ICU患者进行了一项回顾性队列研究[IRBN992021/CHUSTE]。剂量并非恒定；因此，考虑了浓度与剂量之比（C/D）。进行统计分析以评估头孢噻肟浓度、肾功能和肥胖之间的关系。共纳入70例患者，中位年龄61岁，肥胖患者和非肥胖患者的头孢噻肟浓度无显著差异。然而，浓度随GFR有显著变化，肾功能正常至增强的患者普遍存在剂量不足，而肾功能严重受损的患者则存在剂量过量。根据GFR调整头孢噻肟剂量与提高目标达成率相关。重症患者的头孢噻肟给药应考虑肾功能，GFR正常至增强的患者需要更高的初始剂量，而肾功能严重受损的患者需要更低的剂量。治疗药物监测可能有助于优化给药方案。有必要进行前瞻性研究以验证这些发现并为临床实践提供依据。
