The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study
Background: 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 con...
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| Format: | Article |
| Language: | English |
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Oxford University Press for the Infectious Diseases Society of America
2020
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| Online Access: | http://irep.iium.edu.my/81770/ http://irep.iium.edu.my/81770/1/81770_The%20effect%20of%20renal%20replacement%20therapy.pdf |
| _version_ | 1848789183007555584 |
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| author | Roberts, Jason A. Joynt, Gavin M. 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 Waele, Jan J De 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 K Lipman, Jeffrey |
| author_facet | Roberts, Jason A. Joynt, Gavin M. 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 Waele, Jan J De 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 K Lipman, Jeffrey |
| author_sort | Roberts, Jason A. |
| building | IIUM Repository |
| collection | Online Access |
| description | Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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. |
| first_indexed | 2025-11-14T17:52:40Z |
| format | Article |
| id | iium-81770 |
| institution | International Islamic University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T17:52:40Z |
| publishDate | 2020 |
| publisher | Oxford University Press for the Infectious Diseases Society of America |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | iium-817702020-11-24T04:15:28Z http://irep.iium.edu.my/81770/ The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study Roberts, Jason A. Joynt, Gavin M. 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 Waele, Jan J De 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 K Lipman, Jeffrey RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid Background: 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. Methods: 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. Results: 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. Conclusions: 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. Oxford University Press for the Infectious Diseases Society of America 2020-03-09 Article PeerReviewed application/pdf en http://irep.iium.edu.my/81770/1/81770_The%20effect%20of%20renal%20replacement%20therapy.pdf Roberts, Jason A. and Joynt, Gavin M. and Lee, Anna and Choi, Gordon and Bellomo,, Rinaldo and Kanji, Salmaan and Mudaliar, M Yugan and Peake, Sandra L and Stephens, Dianne and Taccone, Fabio Silvio and Ulldemolins, Marta and Valkonen, Miia Maaria and Agbeve, Julius and Baptista, João P and Bekos, Vasileios and Boidin, Clement and Brinkmann, Alexander and Buizen, Luke and Castro, Pedro and Cole, C Louise and Creteur, Jacques and Waele, Jan J De and Deans, Renae and Eastwood, Glenn M and Escobar, Leslie and Gomersall, Charles and Gresham, Rebecca and Jamal, Janattul Ain and Kluge, Stefan and König, Christina and Koulouras, Vasilios P and Lassig-Smith, Melissa and Laterre, Pierre-Francois and Lei, Katie and Leung, Patricia and Lefrant, Jean-Yves and Llauradó-Serra, Mireia and Martin-Loeches, Ignacio and Mat Nor, Mohd Basri and Ostermann, Marlies and Parker, Suzanne L and Rello, Jordi and Roberts, Darren M and Roberts, Michael S and Richards, Brent and Rodríguez, Alejandro and Roehr, Anka C and Roger, Claire and Seoane, Leonardo and Sinnollareddy, Mahipal and Sousa, Eduardo and Soy, Dolors and Spring, Anna and Starr, Therese and Thomas, Jane and Turnidge, John and Wallis, Steven C and Williams, Tricia and Wittebole, Xavier and Zikou, Xanthi T and Paul, Sanjoy K and Lipman, Jeffrey (2020) The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study. Clinical Infectious Disease. pp. 1-32. ISSN 1058-4838 E-ISSN 1537-6591 (In Press) https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa224/5801228?redirectedFrom=fulltext https://doi.org/10.1093/cid/ciaa224 |
| spellingShingle | RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid Roberts, Jason A. Joynt, Gavin M. 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 Waele, Jan J De 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 K Lipman, Jeffrey The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title | The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title_full | The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title_fullStr | The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title_full_unstemmed | The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title_short | The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| title_sort | effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: data from the multinational sampling antibiotics in renal replacement therapy study |
| topic | RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid |
| url | http://irep.iium.edu.my/81770/ http://irep.iium.edu.my/81770/ http://irep.iium.edu.my/81770/ http://irep.iium.edu.my/81770/1/81770_The%20effect%20of%20renal%20replacement%20therapy.pdf |