A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation.
critically ill patients
exposure
extracorporeal membrane oxygenation
invasive fungal infections
pharmacokinetics
therapeutic drug monitoring
variability
voriconazole
Journal
Microorganisms
ISSN: 2076-2607
Titre abrégé: Microorganisms
Pays: Switzerland
ID NLM: 101625893
Informations de publication
Date de publication:
20 Jul 2021
20 Jul 2021
Historique:
received:
31
05
2021
revised:
12
07
2021
accepted:
14
07
2021
entrez:
7
8
2021
pubmed:
8
8
2021
medline:
8
8
2021
Statut:
epublish
Résumé
Voriconazole is one of the first-line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population. Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit's binding sites over time. Sixty-nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO ( No significant ECMO-effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations.
Sections du résumé
BACKGROUND
BACKGROUND
Voriconazole is one of the first-line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population.
METHODS
METHODS
Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit's binding sites over time.
RESULTS
RESULTS
Sixty-nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO (
CONCLUSIONS
CONCLUSIONS
No significant ECMO-effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations.
Identifiants
pubmed: 34361978
pii: microorganisms9071543
doi: 10.3390/microorganisms9071543
pmc: PMC8303158
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Intensive Care Med. 2007 Jun;33(6):1018-24
pubmed: 17404709
Drug Metab Rev. 2019 Aug;51(3):247-265
pubmed: 31215810
Intensive Care Med. 2009 Jan;35(1):183-4
pubmed: 18795256
ASAIO J. 2021 Mar 29;:
pubmed: 33788798
J Fungi (Basel). 2020 Jun 22;6(2):
pubmed: 32580296
Basic Clin Pharmacol Toxicol. 2020 Dec;127(6):495-504
pubmed: 32639669
Crit Care. 2018 Apr 17;22(1):98
pubmed: 29665838
Lancet. 2021 Feb 6;397(10273):499-509
pubmed: 33549194
Transpl Infect Dis. 2021 Jun;23(3):e13545
pubmed: 33316840
J Fungi (Basel). 2020 Jun 24;6(2):
pubmed: 32599813
Int J Antimicrob Agents. 2010 May;35(5):468-72
pubmed: 20188523
J Transl Med. 2020 May 27;18(1):213
pubmed: 32460856
Antimicrob Agents Chemother. 2013 Jul;57(7):3262-7
pubmed: 23629724
Front Pediatr. 2020 Aug 27;8:468
pubmed: 32974242
J Antimicrob Chemother. 2014 May;69(5):1162-76
pubmed: 24379304
J Antimicrob Chemother. 2021 Apr 13;76(5):1234-1241
pubmed: 33517360
Ann Clin Microbiol Antimicrob. 2017 Sep 11;16(1):60
pubmed: 28893246
Crit Care. 2018 Dec 22;22(1):355
pubmed: 30577863
J Antimicrob Chemother. 2009 Apr;63(4):767-70
pubmed: 19218271
J Clin Pharm Ther. 2019 Aug;44(4):572-578
pubmed: 30851209
Perfusion. 2020 Sep;35(6):529-533
pubmed: 32627659
J Clin Pharm Ther. 2017 Dec;42(6):661-671
pubmed: 28948652
Intensive Care Med. 2012 Nov;38(11):1761-8
pubmed: 22895826
Clin Infect Dis. 2016 Aug 15;63(4):e1-e60
pubmed: 27365388
Int J Environ Res Public Health. 2021 Jan 28;18(3):
pubmed: 33525739
Am J Health Syst Pharm. 2016 Mar 1;73(5 Suppl 1):S14-21
pubmed: 26896521
J Antimicrob Chemother. 2017 Mar 1;72(suppl_1):i39-i47
pubmed: 28355466
Clin Microbiol Infect. 2013 Dec;19(12):1115-21
pubmed: 24118188
ASAIO J. 2003 Jan-Feb;49(1):41-7
pubmed: 12558306
J Antimicrob Chemother. 2019 Mar 1;74(3):761-767
pubmed: 30476108
Crit Care. 2015 Jan 12;19:7
pubmed: 25928694
Curr Opin Crit Care. 2015 Oct;21(5):421-9
pubmed: 26165502
Ther Drug Monit. 2008 Feb;30(1):117-9
pubmed: 18223474
Pharmacotherapy. 2020 Jan;40(1):89-95
pubmed: 31742741
Ther Drug Monit. 2008 Dec;30(6):643-6
pubmed: 19057370
Lancet. 2016 Feb 20;387(10020):760-9
pubmed: 26684607