Pau-Parra Alba, Núñez-Núñez María, Sadyrbaeva-Dolgova Svetlana, Doménech Moral Laura, Campelo Sánchez Eva, Periañez Parraga Leonor Del Mar, Saeed Khan Khalid, Luque Pardos Sònia
Servicio de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Grupo de investigación en Farmacia básica, transnacional y clínica, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
Servicio de Farmacia, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (IBS-Granada), Granada, Spain; Centro de Investigación Biomédica en Epidemiología y Salud Púbica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
Farm Hosp. 2025 May-Jun;49(3):T179-T183. doi: 10.1016/j.farma.2024.11.005. Epub 2024 Dec 15.
Infections caused by multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients present a challenge for timely and appropriate antibiotic treatment. This is particularly important in patients undergoing extracorporeal life-support techniques such as renal replacement therapy and extracorporeal membrane oxygenation. These techniques can introduce additional pharmacokinetic alterations, potentially leading to suboptimal exposure to antibiotics. This study aims to outline dosing strategies and therapeutic drug monitoring protocols for new β-lactam antibiotics effective against MDR-GNB in critically ill patients undergoing extracorporeal life-support techniques at a national level. Additionally, the study seeks to develop a consensus document, based on available evidence.
The project will comprise two main phases: I) a national survey and II) the development of a consensus document. This consensus document, undertaken according to ACCORD guidelines, will encompass: a) establishment of a multidisciplinary panel of experts, b) prospective registration of the consensus, c) evidence synthesis, d) modified Delphi rounds. The antimicrobials to be included will be: meropenem, ceftazidime/avibactam, ceftolozane/tazobactam, cefiderocol, meropenem/vaborbactam, imipenem/relebactam, and aztreonam. Extracorporeal life-support techniques will include continuous renal replacement therapy, conventional intermittent hemodialysis, and extracorporeal membrane oxygenation.
The availability of extracorporeal life-support techniques has expanded significantly in recent years, alongside a rise in the prevalence of infections caused by MDR-GNB. There is a need to develop evidence-based tools of high quality to standardize dosing and monitoring strategies for new β-lactam antibiotics.
重症患者中由多重耐药革兰氏阴性杆菌（MDR-GNB）引起的感染给及时且恰当的抗生素治疗带来了挑战。这在接受体外生命支持技术（如肾脏替代治疗和体外膜肺氧合）的患者中尤为重要。这些技术会引发额外的药代动力学改变，可能导致抗生素暴露不足。本研究旨在概述针对在国家层面接受体外生命支持技术的重症患者中对MDR-GNB有效的新型β-内酰胺类抗生素的给药策略和治疗药物监测方案。此外，该研究旨在基于现有证据制定一份共识文件。
该项目将包括两个主要阶段：一）全国性调查；二）共识文件的制定。这份根据ACCORD指南制定的共识文件将涵盖：a）组建多学科专家小组；b）对共识进行前瞻性登记；c）证据综合；d）改良德尔菲轮次。纳入的抗菌药物将包括：美罗培南、头孢他啶/阿维巴坦、头孢洛扎/他唑巴坦、头孢地尔、美罗培南/瓦博巴坦、亚胺培南/瑞来巴坦和氨曲南。体外生命支持技术将包括持续肾脏替代治疗、传统间歇性血液透析和体外膜肺氧合。
近年来，体外生命支持技术的可用性显著增加，与此同时，由MDR-GNB引起的感染患病率也在上升。需要开发高质量的循证工具，以规范新型β-内酰胺类抗生素的给药和监测策略。
