دورية أكاديمية
Therapeutic drug monitoring of meropenem and piperacillin-tazobactam in the Singapore critically ill population - A prospective, multi-center, observational study (BLAST 1).
| العنوان: | Therapeutic drug monitoring of meropenem and piperacillin-tazobactam in the Singapore critically ill population - A prospective, multi-center, observational study (BLAST 1). |
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| المؤلفون: | Chua NG; Department of Pharmacy, Singapore General Hospital, Singapore., Loo L; Department of Pharmacy, Singapore General Hospital, Singapore., Hee DKH; Changi General Hospital, Singapore., Lim TP; Department of Pharmacy, Singapore General Hospital, Singapore., Ng TM; Department of Pharmacy, Tan Tock Seng Hospital, Singapore., Hoo GSR; Department of Pharmacy, Tan Tock Seng Hospital, Singapore., Soong JL; Department of Pharmacy, Singapore General Hospital, Singapore., Ong JCL; Department of Pharmacy, Singapore General Hospital, Singapore., Tang SSL; Department of Pharmacy, Singapore General Hospital, Singapore., Zhou YP; Department of Pharmacy, Singapore General Hospital, Singapore., Lee W; Department of Pharmacy, Singapore General Hospital, Singapore., Lee LS; Department of Medicine, National University Hospital, National University Health System, Singapore., Cove M; Department of Medicine, National University Hospital, National University Health System, Singapore., Ling LM; Mount Elizabeth Novena Specialist Centre, Singapore., Kwa AL; Department of Pharmacy, Singapore General Hospital, Singapore; Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore; SingHealth Duke-National University of Singapore Medicine Academic Clinical Programme, Singapore. Electronic address: andrea.kwa.l.h@sgh.com.sg. |
| المصدر: | Journal of critical care [J Crit Care] 2022 Apr; Vol. 68, pp. 107-113. Date of Electronic Publication: 2022 Jan 06. |
| نوع المنشور: | Journal Article; Observational Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: W.B. Saunders Country of Publication: United States NLM ID: 8610642 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8615 (Electronic) Linking ISSN: 08839441 NLM ISO Abbreviation: J Crit Care Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Philadelphia Pa : W.B. Saunders Original Publication: Orlando, FL : Grune & Stratton, c1986- |
| مواضيع طبية MeSH: | Critical Illness*/therapy , Drug Monitoring*, Adult ; Anti-Bacterial Agents ; Humans ; Meropenem ; Microbial Sensitivity Tests ; Piperacillin/therapeutic use ; Piperacillin, Tazobactam Drug Combination ; Prospective Studies ; Singapore ; beta-Lactams/therapeutic use |
| مستخلص: | Purpose: To determine percentage of patients with sub-therapeutic beta-lactam exposure in our intensive care units (ICU) and to correlate target attainment with clinical outcomes. Materials and Methods: Multi-centre, prospective, observational study was conducted in ICUs from three hospitals in Singapore from July 2016 to May 2018. Adult patients (≥21 years) receiving meropenem or piperacillin-tazobactam were included. Four blood samples were obtained during a dosing interval to measure and determine attainment of therapeutic targets: unbound beta-lactam concentration above (i) minimum inhibitory concentration (MIC) at 40% (meropenem) or 50% (piperacillin) of dosing interval (40-50%fT > MIC) and (ii) 5 × MIC at 100% of dosing interval (100%fT > 5 × MIC). Correlation to clinical outcomes was evaluated using Cox regression. Results: Beta-lactam levels were highly variable among 61 patients, with trough meropenem and piperacillin levels at 21.5 ± 16.8 mg/L and 101.6 ± 81.1 mg/L respectively. Among 85 sets of blood samples, current dosing practices were able to achieve 94% success for 40-50%fT > MIC and 44% for 100%fT > 5 × MIC. Failure to achieve 40-50%fT > MIC within 48 h was significantly associated with all-cause mortality (HR: 9.0, 95% CI: 1.8-45.0), after adjustment for APACHE II score. Achievement of 100%fT > 5 × MIC within 48 h was significantly associated with shorter length of hospital stay. Conclusion: Current dosing practices may be suboptimal for ICU patients. Beta-lactam TDM may be useful. Competing Interests: Declaration of Competing Interest All authors have disclosed that they do not have any conflicts of interest. (Copyright © 2022 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Beta-lactam; Critical care; Pharmacodynamic; Pharmacokinetic; Therapeutic drug monitoring |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) 0 (beta-Lactams) 157044-21-8 (Piperacillin, Tazobactam Drug Combination) FV9J3JU8B1 (Meropenem) X00B0D5O0E (Piperacillin) |
| تواريخ الأحداث: | Date Created: 20220109 Date Completed: 20220415 Latest Revision: 20220415 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.jcrc.2021.12.013 |
| PMID: | 34999376 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1557-8615 |
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| DOI: | 10.1016/j.jcrc.2021.12.013 |