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- Title
Impact of extracorporeal membrane oxygenation (ECMO) support on piperacillin exposure in septic patients: a case-control study.
- Authors
Fillâtre, P; Lemaitre, F; Nesseler, N; Schmidt, M; Besset, S; Launey, Y; Maamar, A; Daufresne, P; Flecher, E; Tulzo, Y Le; Tadie, J M; Tattevin, P; Le Tulzo, Y
- Abstract
<bold>Objectives: </bold>To describe the impact of extracorporeal membrane oxygenation (ECMO) devices on piperacillin exposure in ICU patients.<bold>Methods: </bold>This observational, prospective, multicentre, case-control study was performed in the ICUs of two tertiary care hospitals in France. ECMO patients with sepsis treated with piperacillin/tazobactam were enrolled. Control patients were matched according to SOFA score and creatinine clearance. The pharmacokinetics of piperacillin were described based on a population pharmacokinetic model, calculating the proportion of time the piperacillin plasma concentration was above 64 mg/L (i.e. 4× MIC breakpoint for Pseudomonas aeruginosa).<bold>Results: </bold>Forty-two patients were included. Median (IQR) age was 60 years (49-66), SOFA score was 11 (9-14) and creatinine clearance was 47 mL/min (5-95). There was no significant difference in the proportion of time piperacillin concentrations were ≥64 mg/L in patients treated with ECMO and controls during the first administration (P = 0.184) or at steady state (P = 0.309). Following the first administration, 36/42 (86%) patients had trough piperacillin concentrations <64 mg/L. Trough concentrations at steady state were similar in patients with ECMO and controls (P = 0.535). Creatinine clearance ≥40 mL/min was independently associated with piperacillin trough concentration <64 mg/L at steady state [OR = 4.3 (95% CI 1.1-17.7), P = 0.043], while ECMO support was not [OR = 0.5 (95% CI 0.1-2.1), P = 0.378].<bold>Conclusions: </bold>ECMO support has no impact on piperacillin exposure. ICU patients with sepsis are frequently underexposed to piperacillin, which suggests that therapeutic drug monitoring should be strongly recommended for severe infections.
- Subjects
FRANCE; PIPERACILLIN; EXTRACORPOREAL membrane oxygenation; DRUG monitoring; CASE-control method; PSEUDOMONAS aeruginosa; RESEARCH; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; SEPSIS; COMPARATIVE studies; AMPICILLIN; ANTIBIOTICS; LONGITUDINAL method
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2021, Vol 76, Issue 5, p1242
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkab031