Personalized Piperacillin Dosing for the Critically Ill: A Retrospective Analysis of Clinical Experience with Dosing Software and Therapeutic Drug Monitoring to Optimize Antimicrobial Dosing
Optimization of antibiotic dosing is a treatment intervention that is likely to improve outcomes in severe infections. The aim of this retrospective study was to describe the therapeutic exposure of steady state piperacillin concentrations (c<sub>PIP</sub>) and clinical outcome in critic...
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| Main Authors: | , , , , , , , , , |
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| Format: | Book |
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MDPI AG,
2021-06-01T00:00:00Z.
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| Summary: | Optimization of antibiotic dosing is a treatment intervention that is likely to improve outcomes in severe infections. The aim of this retrospective study was to describe the therapeutic exposure of steady state piperacillin concentrations (c<sub>PIP</sub>) and clinical outcome in critically ill patients with sepsis or septic shock who received continuous infusion of piperacillin with dosing personalized through software-guided empiric dosing and therapeutic drug monitoring (TDM). Therapeutic drug exposure was defined as c<sub>PIP</sub> of 32-64 mg/L (2-4× the 'MIC breakpoint' of <i>Pseudomonas aeruginosa</i>). Of the 1544 patients screened, we included 179 patients (335 serum concentrations), of whom 89% achieved the minimum therapeutic exposure of >32 mg/L and 12% achieved potentially harmful c<sub>PIP</sub> > 96 mg/L within the first 48 h. Therapeutic exposure was achieved in 40% of the patients. Subsequent TDM-guided dose adjustments significantly enhanced therapeutic exposure to 65%, and significantly reduced c<sub>PIP</sub> > 96 mg/L to 5%. Mortality in patients with c<sub>PIP</sub> > 96 mg/L (13/21; 62%) (OR 5.257, 95% CI 1.867-14.802, <i>p</i> = 0.001) or 64-96 mg/L (30/76; 45%) (OR 2.696, 95% CI 1.301-5.586, <i>p</i> = 0.007) was significantly higher compared to patients with therapeutic exposure (17/72; 24%). Given the observed variability in critically ill patients, combining the application of dosing software and consecutive TDM increases therapeutic drug exposure of piperacillin in patients with sepsis and septic shock. |
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| Item Description: | 10.3390/antibiotics10060667 2079-6382 |