Suboptimal exposure to fluconazole in critically ill patients: Pharmacokinetic analysis and determinants.
Antifungal stewardship
Critically ill patients
Fluconazole
Pharmacokinetic
Therapeutic drug monitoring
Journal
Infectious diseases now
ISSN: 2666-9919
Titre abrégé: Infect Dis Now
Pays: France
ID NLM: 101775152
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
12
09
2022
revised:
19
10
2022
accepted:
24
10
2022
pubmed:
4
11
2022
medline:
9
3
2023
entrez:
3
11
2022
Statut:
ppublish
Résumé
This study aims at evaluating fluconazole exposure in critically ill patients and identifying variables associated with the latter. This was a 2-year (2018-2019) retrospective multicenter cohort study. Adult patients > 18 years-old with at least one fluconazole concentration measurement during their ICU stay were included. Twenty patients were included. Only 11 patients had a fluconazole trough concentration (Cmin) within the target range (≥15 mg/L). According to bivariable analysis, SOFA score, GGT, fluconazole clearance, Ke, and Vd, were independently associated with a decrease in fluconazole Cmin. The median loading dose required to achieve the Cmin target appeared to be greater in patients with higher SOFA or GGT level and in patients undergoing renal replacement therapy. This study supports recommendation for routine fluconazole therapeutic drug monitoring in ICU patients so as to avoid underexposure, especially if SOFA score is ≥ 7 and/or GGT is ≥ 100 U/L.
Identifiants
pubmed: 36328312
pii: S2666-9919(22)00231-7
doi: 10.1016/j.idnow.2022.10.002
pii:
doi:
Substances chimiques
Fluconazole
8VZV102JFY
Antifungal Agents
0
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
104630Investigateurs
Florence Ader
(F)
Laurent Argaud
(L)
Frédéric Aubrun
(F)
Jean-Luc Fellahi
(JL)
Céline Guichon
(C)
Laurent Juillard
(L)
Vincent Leclerc
(V)
Charline Miossec
(C)
Carole Paillet
(C)
Alexandra Plesa
(A)
Jean-Christophe Richard
(JC)
Sandrine Roux
(S)
Florent Wallet
(F)
Informations de copyright
Copyright © 2022 Elsevier Masson SAS. All rights reserved.