Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22797
Title: The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: Data from the multinational SMARRT Study.
Authors: Roberts, Jason A;Joynt, Gavin;Lee, Anna;Choi, Gordon;Bellomo, Rinaldo;Kanji, Salmaan;Mudaliar, M Yugan;Peake, Sandra L;Stephens, Dianne;Taccone, Fabio Silvio;Ulldemolins, Marta;Valkonen, Miia Maaria;Agbeve, Julius;Baptista, João P;Bekos, Vasileios;Boidin, Clement;Brinkmann, Alexander;Buizen, Luke;Castro, Pedro;Cole, C Louise;Creteur, Jacques;De Waele, Jan J;Deans, Renae;Eastwood, Glenn M;Escobar, Leslie;Gomersall, Charles;Gresham, Rebecca;Jamal, Janattul Ain;Kluge, Stefan;König, Christina;Koulouras, Vasilios P;Lassig-Smith, Melissa;Laterre, Pierre-Francois;Lei, Katie;Leung, Patricia;Lefrant, Jean-Yves;Llauradó-Serra, Mireia;Martin-Loeches, Ignacio;Mat Nor, Mohd Basri;Ostermann, Marlies;Parker, Suzanne L;Rello, Jordi;Roberts, Darren M;Roberts, Michael S;Richards, Brent;Rodríguez, Alejandro;Roehr, Anka C;Roger, Claire;Seoane, Leonardo;Sinnollareddy, Mahipal;Sousa, Eduardo;Soy, Dolors;Spring, Anna;Starr, Therese;Thomas, Jane;Turnidge, John;Wallis, Steven C;Williams, Tricia;Wittebole, Xavier;Zikou, Xanthi T;Paul, Sanjoy;Lipman, Jeffrey
Affiliation: The Ottawa Hospital Research Institute, Ottawa, Canada
School of Medicine, The University of Melbourne, Melbourne, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki, Helsinki, Finland
Helsinki University Hospital, Helsinki, Finland
Department of Intensive Care, Erasme Hospital, Brussels, Belgium
Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon
Université Claude Bernard Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Therapeutics Research Centre, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia
Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Australia
Translational Research Institute, The University of Queensland, Buranda, Australia
Intensive Care Unit, Nepean Hospital, Sydney, Australia
Medical School, University of Sydney, Sydney, Australia
Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, Herston Australia
Flinders University, Adelaide, Australia
National Critical Care and Trauma Response Centre, Darwin, Australia
Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
Intensive Care Unit, Westmead Hospital, Sydney, Australia
IDIBAPS. University of Barcelona. Barcelona, Spain
Pharmacy Department, Division of Medicines. Hospital Clínic de Barcelona
Faculty of Medicine, The University of Queensland, New Orleans, USA
Intensive Care Unit, Ochsner Health System, New Orleans, USA
Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain
Rovira i Virgili University, IISPV/CIBERES, Tarragona, Spain
Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Spain
Multidisciplinary Intensive Care Research Organization (MICRO), St James Hospital, Dublin, Ireland
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Germany
Medical Intensive Care Unit, ICMiD. Hospital Clínic de Barcelona
IDIBAPS. University of Barcelona. Barcelona, Spain
Fundació Privada Clínic per la Recerca Biomèdica, Barcelona, Spain
Infectious Diseases-Internal Medicine Departments, Bellvitge University Hospital, l'Hospitalet de Llobregat, Spain
Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada
Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Australia
Department of Intensive Care Medicine, The Queen Elizabeth Hospital; Woodville; Australia
School of Medicine, University of Adelaide, Adelaide, South Australia
School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria..
Intensive Care Unit, Royal Darwin Hospital, Darwin, Australia
Intensive Care Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Intensive Care Unit, Naval and Veterans Hospital of Athens, Athens, Greece
Department of Anesthesia and Critical Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany
Department of Intensive Care, Erasme Hospital, Brussels, Belgium
Department of Critical Care Medicine; Ghent University Hospital, Ghent, Belgium
Faculty of Medicine. Universidad de Chile, Santiago, Chile
Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
Department of Pharmacy, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
ICU Department, University Hospital of Ioannina, Ioannina, Greece
Intensive Care Unit, Clinique Universitaire St Luc UCL, Brussels, Belgium
Guy's & St Thomas Hospital, London, United Kingdom
Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
Intensive Care Unit, Nîmes University Hospital Centre Hospitalo Universitaire Nimes)
Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
Department of Anaesthesiology & Intensive Care, School of Medicine, International Islamic University Malaysia, Malaysia
Guy's & St Thomas Hospital, London, United Kingdom
CIBERES, Vall d'Hebron Institute of Research, Barcelona, Spain
Department of Pharmacy, General Hospital of Heidenheim Heidenheim, Germany
Intensive Care Unit, Nîmes University Hospital Centre Hospitalo Universitaire Nimes)
Intensive Care Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Intensive Care Unit, Naval and Veterans Hospital of Athens, Athens, Greece
Intensive Care Unit, Clinique Universitaire St Luc UCL, Brussels, Belgium
University Hospital of Ioannina, Ioannina, Greece
Issue Date: 9-Mar-2020
EDate: 2020-03-09
Citation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2020; online first: 9 March
Abstract: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. We performed a prospective, observational, multi-national, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam and vancomycin and related them to high and low target trough concentrations. We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8 fold) in antibiotic dosing regimens; RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/min (interquartile range [IQR] 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (p<0.05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin 78.6 mg/L (49.5-127.3), tazobactam 9.5 mg/L (6.3-14.2) and vancomycin 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, 72%, and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin and vancomycin respectively. In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22797
DOI: 10.1093/cid/ciaa224
ORCID: 0000-0002-1650-8939
PubMed URL: 32150603
Type: Journal Article
Subjects: beta-lactam
continuous renal replacement therapy
extended daily dialysis
pharmacokinetic
renal clearance
trough concentration
Appears in Collections:Journal articles

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