Observational study of cefepime therapeutic drug monitoring in continuous venovenous hemodialysis.

PURPOSE

The purpose of this study is to describe cefepime pharmacokinetics (PK) as well as investigate the factors that predict the achievement of PK/pharmacodynamic (PD) targets, attainment of supratherapeutic total cefepime levels, and occurrence of potential cefepime-induced neurotoxicity (CIN) in critically ill patients receiving continuous venovenous hemodialysis (CVVHD).

METHODS

This was a single-center, retrospective, observational study of adult patients admitted to the intensive care unit who received cefepime therapeutic drug monitoring (TDM) while on CVVHD. Binomial logistic regressions were performed to assess the association between clinical and PK factors, and the achievement of target attainment and safety endpoints. The presence of potential CIN was assessed using the Naranjo scale.

RESULTS

Forty-five patients were included. Target attainment was achieved in 28 (62.2 %) patients. Cefepime total daily dose (TDD) >3 g was associated with an increased likelihood of achieving target attainment (p = 0.043). The safety endpoint occurred in 15 (33.33 %) patients. Higher body mass index (p = 0.049), cefepime TDD >3 g (p = 0.029), and lower CVVHD therapy rate (p = 0.033) were associated with elevated cefepime levels. Potential CIN occurred in 13 (28.8 %) patients. Higher total cefepime trough levels were associated with an increased likelihood of developing CIN (p = 0.033).

CONCLUSION

Given the risk for potential CIN, critically ill patients requiring CVVHD may benefit from TDM to guide cefepime dosing.