Cargando…
Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam
AIM: We sought to correlate pharmacokinetic (PK)/pharmacodynamic (PD) predictions of antibacterial efficacy and clinical outcomes in patients with augmented renal clearance (ARC) and Pseudomonas aeruginosa bacteremia or pneumonia treated with extended infusion cefepime or piperacillin/tazobactam. MA...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792402/ https://www.ncbi.nlm.nih.gov/pubmed/31620353 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_70_18 |
_version_ | 1783459148129632256 |
---|---|
author | Gerlach, Anthony T. Wenzler, Eric Hunt, Lauren N. Bazan, Jose A. Bauer, Karri A. |
author_facet | Gerlach, Anthony T. Wenzler, Eric Hunt, Lauren N. Bazan, Jose A. Bauer, Karri A. |
author_sort | Gerlach, Anthony T. |
collection | PubMed |
description | AIM: We sought to correlate pharmacokinetic (PK)/pharmacodynamic (PD) predictions of antibacterial efficacy and clinical outcomes in patients with augmented renal clearance (ARC) and Pseudomonas aeruginosa bacteremia or pneumonia treated with extended infusion cefepime or piperacillin/tazobactam. MATERIALS AND METHODS: Cefepime (2 g every 8 h) and piperacillin/tazobactam (4.5 g every 8 h) were administered over 4 h after a loading dose infused over 30 min, and minimum inhibitory concentration was determined by E-test. Published population PK evaluations in critically ill patients were used, and PD analyses were conducted using estimated patient-specific PK parameters and known minimum inhibitory concentration values for P. aeruginosa. Concentration–time profiles were generated every 6 min using first-dose drug exposure estimates including a loading infusion, and free concentration above the minimum inhibitory concentration (fT> MIC) was estimated. Clinical cure was defined as resolution of signs and symptoms attributable to P. aeruginosa infection without need for escalation of antimicrobial. RESULTS: One hundred and two patients were included (36 cefepime and 66 piperacillin/tazobactam). The two groups of patients had similar age, serum creatinine, weight, and creatinine clearance. The majority of patients required intensive care unit care (63.9% vs. 63.6%) and most had pneumonia (61%). The fT>MIC (93.6 [69.9–100] vs. 57.2 [47.6–72.4], P < 0.001) and clinical cure (91.7% vs. 74.2%, P = 0.039) were significantly higher in cefepime group, whereas mortality (8.3% vs. 22.7%, P = 0.1) and infection-related mortality (0% vs. 2%, P = 0.54) were similar. CONCLUSIONS: Patients with ARC and P. aeruginosa pneumonia and/or bacteremia who received extended-infusion cefepime achieved higher fT>MIC and clinical cure than those receiving extended infusion piperacillin/tazobactam. |
format | Online Article Text |
id | pubmed-6792402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-67924022019-10-16 Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam Gerlach, Anthony T. Wenzler, Eric Hunt, Lauren N. Bazan, Jose A. Bauer, Karri A. Int J Crit Illn Inj Sci Original Article AIM: We sought to correlate pharmacokinetic (PK)/pharmacodynamic (PD) predictions of antibacterial efficacy and clinical outcomes in patients with augmented renal clearance (ARC) and Pseudomonas aeruginosa bacteremia or pneumonia treated with extended infusion cefepime or piperacillin/tazobactam. MATERIALS AND METHODS: Cefepime (2 g every 8 h) and piperacillin/tazobactam (4.5 g every 8 h) were administered over 4 h after a loading dose infused over 30 min, and minimum inhibitory concentration was determined by E-test. Published population PK evaluations in critically ill patients were used, and PD analyses were conducted using estimated patient-specific PK parameters and known minimum inhibitory concentration values for P. aeruginosa. Concentration–time profiles were generated every 6 min using first-dose drug exposure estimates including a loading infusion, and free concentration above the minimum inhibitory concentration (fT> MIC) was estimated. Clinical cure was defined as resolution of signs and symptoms attributable to P. aeruginosa infection without need for escalation of antimicrobial. RESULTS: One hundred and two patients were included (36 cefepime and 66 piperacillin/tazobactam). The two groups of patients had similar age, serum creatinine, weight, and creatinine clearance. The majority of patients required intensive care unit care (63.9% vs. 63.6%) and most had pneumonia (61%). The fT>MIC (93.6 [69.9–100] vs. 57.2 [47.6–72.4], P < 0.001) and clinical cure (91.7% vs. 74.2%, P = 0.039) were significantly higher in cefepime group, whereas mortality (8.3% vs. 22.7%, P = 0.1) and infection-related mortality (0% vs. 2%, P = 0.54) were similar. CONCLUSIONS: Patients with ARC and P. aeruginosa pneumonia and/or bacteremia who received extended-infusion cefepime achieved higher fT>MIC and clinical cure than those receiving extended infusion piperacillin/tazobactam. Wolters Kluwer - Medknow 2019 2019-09-30 /pmc/articles/PMC6792402/ /pubmed/31620353 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_70_18 Text en Copyright: © 2019 International Journal of Critical Illness and Injury Science http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Gerlach, Anthony T. Wenzler, Eric Hunt, Lauren N. Bazan, Jose A. Bauer, Karri A. Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title | Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title_full | Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title_fullStr | Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title_full_unstemmed | Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title_short | Pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and Pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
title_sort | pharmacokinetic/pharmacodynamic predictions and clinical outcomes of patients with augmented renal clearance and pseudomonas aeruginosa bacteremia and/or pneumonia treated with extended infusion cefepime versus extended infusion piperacillin/tazobactam |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792402/ https://www.ncbi.nlm.nih.gov/pubmed/31620353 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_70_18 |
work_keys_str_mv | AT gerlachanthonyt pharmacokineticpharmacodynamicpredictionsandclinicaloutcomesofpatientswithaugmentedrenalclearanceandpseudomonasaeruginosabacteremiaandorpneumoniatreatedwithextendedinfusioncefepimeversusextendedinfusionpiperacillintazobactam AT wenzlereric pharmacokineticpharmacodynamicpredictionsandclinicaloutcomesofpatientswithaugmentedrenalclearanceandpseudomonasaeruginosabacteremiaandorpneumoniatreatedwithextendedinfusioncefepimeversusextendedinfusionpiperacillintazobactam AT huntlaurenn pharmacokineticpharmacodynamicpredictionsandclinicaloutcomesofpatientswithaugmentedrenalclearanceandpseudomonasaeruginosabacteremiaandorpneumoniatreatedwithextendedinfusioncefepimeversusextendedinfusionpiperacillintazobactam AT bazanjosea pharmacokineticpharmacodynamicpredictionsandclinicaloutcomesofpatientswithaugmentedrenalclearanceandpseudomonasaeruginosabacteremiaandorpneumoniatreatedwithextendedinfusioncefepimeversusextendedinfusionpiperacillintazobactam AT bauerkarria pharmacokineticpharmacodynamicpredictionsandclinicaloutcomesofpatientswithaugmentedrenalclearanceandpseudomonasaeruginosabacteremiaandorpneumoniatreatedwithextendedinfusioncefepimeversusextendedinfusionpiperacillintazobactam |