Pharmacokinetics and Pharmacodynamics of Anti-infective Agents during Continuous Veno-venous Hemofiltration in Critically Ill Patients: Lessons Learned from an Ancillary Study of the IVOIRE Trial.
antibiotic dosage
antibiotics
continuous veno-venous hemofiltration
high volume hemofiltration
pharmacodynamics
pharmacokinetics
septic shock
Journal
Journal of translational internal medicine
ISSN: 2450-131X
Titre abrégé: J Transl Int Med
Pays: Poland
ID NLM: 101673826
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
entrez:
4
2
2020
pubmed:
6
2
2020
medline:
6
2
2020
Statut:
epublish
Résumé
Hemofiltration rate, changes in blood and ultrafiltration flow, and discrepancies between the prescribed and administered doses strongly influence pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobial agents during continuous veno-venous hemofiltration (CVVH) in critically ill patients. Ancillary data were from the prospective multicenter IVOIRE (hIgh VOlume in Intensive caRE) study. High volume (HV, 70 mL/kg/h) was at random compared with standard volume (SV, 35 mL/kg/h) CVVH in septic shock patients with acute kidney injury (AKI). PK/PD parameters for all antimicrobial agents used in each patient were studied during five days. Antimicrobial treatment met efficacy targets for both percentage of time above the minimal inhibitory concentration and inhibitory quotient. A significant correlation was observed between the ultrafiltration flow and total systemic clearance (Spearman test: This study confirms that CVVH influences the PK/PD behavior of most antimicrobial agents. Antimicrobial elimination was directly correlated with convection rate. Current antimicrobial dose recommendations will expose patients to underdosing and increase the risk for treatment failure and development of resistance. Dose recommendations are proposed for some major antibiotic and antifungal treatments in patients receiving at least 25 mL/kg/h CVVH.
Sections du résumé
BACKGROUND
BACKGROUND
Hemofiltration rate, changes in blood and ultrafiltration flow, and discrepancies between the prescribed and administered doses strongly influence pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobial agents during continuous veno-venous hemofiltration (CVVH) in critically ill patients.
METHODS
METHODS
Ancillary data were from the prospective multicenter IVOIRE (hIgh VOlume in Intensive caRE) study. High volume (HV, 70 mL/kg/h) was at random compared with standard volume (SV, 35 mL/kg/h) CVVH in septic shock patients with acute kidney injury (AKI). PK/PD parameters for all antimicrobial agents used in each patient were studied during five days.
RESULTS
RESULTS
Antimicrobial treatment met efficacy targets for both percentage of time above the minimal inhibitory concentration and inhibitory quotient. A significant correlation was observed between the ultrafiltration flow and total systemic clearance (Spearman test:
CONCLUSIONS
CONCLUSIONS
This study confirms that CVVH influences the PK/PD behavior of most antimicrobial agents. Antimicrobial elimination was directly correlated with convection rate. Current antimicrobial dose recommendations will expose patients to underdosing and increase the risk for treatment failure and development of resistance. Dose recommendations are proposed for some major antibiotic and antifungal treatments in patients receiving at least 25 mL/kg/h CVVH.
Identifiants
pubmed: 32010602
doi: 10.2478/jtim-2019-0031
pii: jtim-2019-0031
pmc: PMC6985915
doi:
Types de publication
Journal Article
Langues
eng
Pagination
155-169Informations de copyright
© 2019 Dominique Breilh et al., published by Sciendo.
Déclaration de conflit d'intérêts
Conflict of Interest The authors declare to have no competing interests.
Références
Indian J Crit Care Med. 2014 Jul;18(7):415-6
pubmed: 25097350
Clin Pharmacokinet. 2006;45(8):755-73
pubmed: 16884316
Chemotherapy. 2013;59(2):143-51
pubmed: 24051895
Yakugaku Zasshi. 2010 Jan;130(1):87-94
pubmed: 20046071
Antimicrob Agents Chemother. 2015 Jul;59(7):3935-43
pubmed: 25896706
Int J Antimicrob Agents. 2011 Jun;37(6):531-5
pubmed: 21489756
Crit Care. 2014 Jun 23;18(3):227
pubmed: 25042938
Crit Care. 2015 May 27;19:234
pubmed: 26013496
ASAIO J. 2004 Jan-Feb;50(1):102-9
pubmed: 14763500
Clin Pharmacokinet. 2008;47(3):173-80
pubmed: 18307371
Clin Pharmacokinet. 2006;45(5):493-501
pubmed: 16640454
Crit Care Med. 2009 Mar;37(3):840-51; quiz 859
pubmed: 19237886
Nephrol Dial Transplant. 2010 Apr;25(4):1279-84
pubmed: 20007981
BMC Clin Pharmacol. 2006 Sep 18;6:6
pubmed: 16981986
Pharmacotherapy. 2001 Nov;21(11 Pt 2):319S-330S
pubmed: 11714223
J Chromatogr B Analyt Technol Biomed Life Sci. 2004 Dec 25;813(1-2):145-50
pubmed: 15556527
Intensive Care Med. 2006 Dec;32(12):2013-9
pubmed: 17043848
Crit Care. 2016 Apr 05;20:87
pubmed: 27044560
Intensive Care Med. 2006 May;32(5):713-22
pubmed: 16550372
J Pharm Biomed Anal. 2009 Dec 5;50(5):932-8
pubmed: 19608374
J Antimicrob Chemother. 2005 Jul;56(1):172-9
pubmed: 15905303
Clin Pharmacokinet. 1993 Jan;24(1):10-27
pubmed: 8448970
Adv Chronic Kidney Dis. 2013 Jan;20(1):85-93
pubmed: 23265600
J Clin Pharmacol. 1996 Dec;36(12):1114-9
pubmed: 9013367
Ann Intensive Care. 2015 Dec;5(1):51
pubmed: 26690796
Surgery. 1983 Jan;93(1 Pt 2):149-53
pubmed: 6849199
Crit Care. 2015 Jun 22;19:263
pubmed: 26095659
Intensive Care Med. 2003 Oct;29(10):1844-8
pubmed: 13680113
ASAIO J. 2013 Mar-Apr;59(2):99-106
pubmed: 23438770
Clin Pharmacokinet. 2007;46(12):997-1038
pubmed: 18027987
Acta Anaesthesiol Scand. 2001 Sep;45(8):929-34
pubmed: 11576041
Clin Pharmacol Ther. 1984 Sep;36(3):363-8
pubmed: 6467795
J Am Soc Nephrol. 1995 Aug;6(2):242-7
pubmed: 7579091
Antimicrob Agents Chemother. 2011 Mar;55(3):1187-93
pubmed: 21199922
J Mol Med (Berl). 1995 Mar;73(3):145-7
pubmed: 7633952
Mycoses. 1999 Apr;42(1-2):17-9
pubmed: 10394842
Intensive Care Med. 2013 Sep;39(9):1535-46
pubmed: 23740278
Am J Kidney Dis. 2003 Aug;42(2):310-4
pubmed: 12900813
Antimicrob Agents Chemother. 2002 May;46(5):1557-60
pubmed: 11959598
Antimicrob Agents Chemother. 2010 Nov;54(11):4939-41
pubmed: 20823287
Kidney Int Suppl. 1998 May;66:S165-8
pubmed: 9573596
Pharmacotherapy. 2015 Jun;35(6):600-7
pubmed: 26095008
Nephrol Dial Transplant. 2006 Apr;21(4):1019-23
pubmed: 16311263
J Antimicrob Chemother. 2016 May;71(5):1386-94
pubmed: 26832751
Crit Care. 2011;15(3):R137
pubmed: 21649882
Int J Nephrol Renovasc Dis. 2013 Jun 07;6:107-11
pubmed: 23776390
Eur J Clin Pharmacol. 2000 Dec;56(9-10):671-8
pubmed: 11214774
Blood Purif. 2014;37(4):291-5
pubmed: 25096804
J Clin Pharmacol. 2006 Oct;46(10):1128-38
pubmed: 16988201
Intensive Care Med. 2007 Sep;33(9):1563-70
pubmed: 17594074
Crit Care. 2009;13(2):R57
pubmed: 19368724
Crit Care. 2015 Feb 03;19:32
pubmed: 25645660
Antimicrob Agents Chemother. 2010 Jul;54(7):2974-8
pubmed: 20479205
Intensive Care Med. 2014 Jul;40(7):998-1005
pubmed: 24687298
Blood Purif. 2006;24(5-6):548-54
pubmed: 17124423
Int J Antimicrob Agents. 2004 Nov;24(5):468-72
pubmed: 15519479
Diagn Microbiol Infect Dis. 2015 May;82(1):92-103
pubmed: 25698632
Antimicrob Agents Chemother. 1984 Apr;25(4):438-42
pubmed: 6329080
Int J Antimicrob Agents. 2014 Apr;43(4):343-8
pubmed: 24612982
J Antimicrob Chemother. 2013 Dec;68(12):2859-65
pubmed: 23800905
Crit Care Med. 2009 Jul;37(7):2268-82
pubmed: 19487930
Pharmacotherapy. 2000 Jun;20(6):635-43
pubmed: 10853618
Crit Care Med. 2000 Nov;28(11):3581-7
pubmed: 11098957
Am J Kidney Dis. 2004 Dec;44(6):1097-102
pubmed: 15558532
J Antimicrob Chemother. 2014 Jan;69(1):180-9
pubmed: 23908259
Ther Drug Monit. 2008 Feb;30(1):117-9
pubmed: 18223474
J Crit Care. 2014 Dec;29(6):1089-95
pubmed: 25179412
Crit Care Med. 2008 May;36(5):1500-6
pubmed: 18434883
Pharm World Sci. 2005 Oct;27(5):371-5
pubmed: 16341743
J Chromatogr B Analyt Technol Biomed Life Sci. 2006 Jan 18;830(2):218-23
pubmed: 16290251
Contrib Nephrol. 2003;(138):144-52
pubmed: 12463156
Clin Infect Dis. 2005 Oct 15;41(8):1159-66
pubmed: 16163635
Antimicrob Agents Chemother. 2005 Jun;49(6):2421-8
pubmed: 15917542