Gras-Martín Laura, Plaza-Diaz Adrián, Zarate-Tamames Borja, Vera-Artazcoz Paula, Torres Olga H, Bastida Carla, Soy Dolors, Ruiz-Ramos Jesús
Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
Institut de Recerca Sant Pau (IR SANT PAU), Sat Quintí 77-79, 08041 Barcelona, Spain.
Antibiotics (Basel). 2024 Aug 24;13(9):801. doi: 10.3390/antibiotics13090801.
(1) Background: Knowledge about the behavior of antibiotics in critically ill patients has been increasing in recent years. Some studies have concluded that a high percentage may be outside the therapeutic range. The most likely cause of this is the pharmacokinetic variability of critically ill patients, but it is not clear which factors have the greatest impact. The aim of this systematic review is to identify risk factors among critically ill patients that may exhibit significant pharmacokinetic alterations, compromising treatment efficacy and safety. (2) Methods: The search included the PubMed, Web of Science, and Embase databases. (3) Results: We identified 246 observational studies and ten clinical trials. The most studied risk factors in the literature were renal function, weight, age, sex, and renal replacement therapy. Risk factors with the greatest impact included renal function, weight, renal replacement therapy, age, protein or albumin levels, and APACHE or SAPS scores. (4) Conclusions: The review allows us to identify which critically ill patients are at a higher risk of not reaching therapeutic targets and helps us to recognize the extensive number of risk factors that have been studied, guiding their inclusion in future studies. It is essential to continue researching, especially in real clinical practice and with clinical outcomes.
（1）背景：近年来，关于重症患者抗生素行为的知识不断增加。一些研究得出结论，很大比例的抗生素浓度可能超出治疗范围。最可能的原因是重症患者的药代动力学变异性，但尚不清楚哪些因素影响最大。本系统评价的目的是确定重症患者中可能出现显著药代动力学改变、影响治疗效果和安全性的危险因素。（2）方法：检索了PubMed、科学网和Embase数据库。（3）结果：我们纳入了246项观察性研究和10项临床试验。文献中研究最多的危险因素是肾功能、体重、年龄、性别和肾脏替代治疗。影响最大的危险因素包括肾功能、体重、肾脏替代治疗、年龄、蛋白质或白蛋白水平以及急性生理与慢性健康状况评分系统（APACHE）或简化急性生理学评分（SAPS）。（4）结论：该评价使我们能够确定哪些重症患者未达到治疗目标的风险较高，并帮助我们认识到已研究的大量危险因素，为未来研究中纳入这些因素提供指导。继续开展研究至关重要，尤其是在实际临床实践和临床结局方面的研究。
