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Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity

Continuous infusion (CI) with high doses of cefepime is recommended in the empirical antimicrobial regimen of critically ill patients with suspected Gram-negative sepsis. This study aimed to determine factors associated with cefepime overdosing and the incidence of cefepime-induced neurotoxicity (CI...

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Autores principales: Jean-Michel, Vanessa, Homey, Corentin, Devos, Patrick, Delannoy, Pierre-Yves, Boussekey, Nicolas, Caulier, Thomas, Leroy, Olivier, Georges, Hugues
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854724/
https://www.ncbi.nlm.nih.gov/pubmed/36671270
http://dx.doi.org/10.3390/antibiotics12010069
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author Jean-Michel, Vanessa
Homey, Corentin
Devos, Patrick
Delannoy, Pierre-Yves
Boussekey, Nicolas
Caulier, Thomas
Leroy, Olivier
Georges, Hugues
author_facet Jean-Michel, Vanessa
Homey, Corentin
Devos, Patrick
Delannoy, Pierre-Yves
Boussekey, Nicolas
Caulier, Thomas
Leroy, Olivier
Georges, Hugues
author_sort Jean-Michel, Vanessa
collection PubMed
description Continuous infusion (CI) with high doses of cefepime is recommended in the empirical antimicrobial regimen of critically ill patients with suspected Gram-negative sepsis. This study aimed to determine factors associated with cefepime overdosing and the incidence of cefepime-induced neurotoxicity (CIN) in these patients. We performed a retrospective study including all patients receiving cefepime treatment between January 2019 and May 2022. The plasma level of cefepime defining overdosing was over 35 mg/L. Neurotoxicity was defined according to strict criteria and correlated with concomitant steady-state concentration of cefepime. Seventy-eight courses of cefepime treatment were analyzed. The mean cefepime plasma level at steady state was 59.8 ± 29.3 mg/L, and overdosing occurred in 80% of patients. Renal failure and a daily dose > 5 g were independently associated with overdosing. CIN was present in 30% of patients. In multivariate analysis, factors associated with CIN were chronic renal failure and a cefepime plasma concentration ≥ 60 mg/L. CIN was not associated with mortality. Overdosing is frequent in patients receiving high doses of cefepime by CI. Steady-state levels are higher than targeted therapeutic pharmacokinetic/pharmacodynamic objectives. The risk of CIN is important when the plasma concentration is ≥60 mg/L.
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spelling pubmed-98547242023-01-21 Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity Jean-Michel, Vanessa Homey, Corentin Devos, Patrick Delannoy, Pierre-Yves Boussekey, Nicolas Caulier, Thomas Leroy, Olivier Georges, Hugues Antibiotics (Basel) Review Continuous infusion (CI) with high doses of cefepime is recommended in the empirical antimicrobial regimen of critically ill patients with suspected Gram-negative sepsis. This study aimed to determine factors associated with cefepime overdosing and the incidence of cefepime-induced neurotoxicity (CIN) in these patients. We performed a retrospective study including all patients receiving cefepime treatment between January 2019 and May 2022. The plasma level of cefepime defining overdosing was over 35 mg/L. Neurotoxicity was defined according to strict criteria and correlated with concomitant steady-state concentration of cefepime. Seventy-eight courses of cefepime treatment were analyzed. The mean cefepime plasma level at steady state was 59.8 ± 29.3 mg/L, and overdosing occurred in 80% of patients. Renal failure and a daily dose > 5 g were independently associated with overdosing. CIN was present in 30% of patients. In multivariate analysis, factors associated with CIN were chronic renal failure and a cefepime plasma concentration ≥ 60 mg/L. CIN was not associated with mortality. Overdosing is frequent in patients receiving high doses of cefepime by CI. Steady-state levels are higher than targeted therapeutic pharmacokinetic/pharmacodynamic objectives. The risk of CIN is important when the plasma concentration is ≥60 mg/L. MDPI 2022-12-30 /pmc/articles/PMC9854724/ /pubmed/36671270 http://dx.doi.org/10.3390/antibiotics12010069 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Jean-Michel, Vanessa
Homey, Corentin
Devos, Patrick
Delannoy, Pierre-Yves
Boussekey, Nicolas
Caulier, Thomas
Leroy, Olivier
Georges, Hugues
Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title_full Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title_fullStr Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title_full_unstemmed Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title_short Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity
title_sort continuous infusion of high doses of cefepime in intensive care unit: assessment of steady-state plasma level and incidence on neurotoxicity
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854724/
https://www.ncbi.nlm.nih.gov/pubmed/36671270
http://dx.doi.org/10.3390/antibiotics12010069
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