Study reveals antibiotic dosing gaps in septic shock patients
A Swedish hospital study found that critically ill septic shock patients often don't receive adequate antibiotic concentrations with standard dosing schedules, potentially affecting treatment outcomes. The findings suggest hospitals may need to adjust how they administer beta-lactam antibiotics to ensure drugs reach effective levels in the bloodstream.
Originaltitel: Time over minimum inhibitory concentration and variations in beta-lactam concentrations during prolonged and intermittent infusions in patients with septic shock: A post hoc observational study.
**Betaaktam-exponeringen hos septiska patienter varierar kraftigt – infusionsmetod och njurfunktion avgör effekt** Septicemia kräver snabb antibiotikaläkning, men många kritiskt sjuka uppnår inte målkoncentrationer. Forskare vid Lund University analyserade antibiotikahalter hos 21 intensivvårdspatienter med septic shock för att jämföra prolongerad och intermittent infusion. Under 72 timmar analyserades 341 blodprover. Alla patienter uppnådde minsta hämningskoncentration (MIC) hela tiden, men endast 83 procent nådde fyra gånger MIC genomgående. Kontinuerlig njurrengöring (CRRT) påverkade antibiotikakoncentrationerna signifikant. Studien från Helsingborg sjukhus visar att infusionsmetod och njurstatus direkt påverkar betaaktam-exponeringen. För inköpschefer och kliniker innebär detta att doseringsprotokoll måste anpassas efter patientens njurfunktion för att säkerställa farmakologisk effekt vid septisk chock.
ObjectiveCritically ill patients with septic shock frequently exhibit variability in antibiotic pharmacokinetics. We aimed to investigate the antibiotic concentration and time over minimum inhibitory concentration in patients with septic shock treated with prolonged and intermittent infusions.MethodsWe performed a post hoc analysis of a prospective study of patients with septic shock admitted to the intensive care unit at Helsingborg hospital from 2016 to 2018. Plasma samples were collected every 4 h for the initial 72 h following intensive care unit admission. We analyzed samples for cefotaxime (intermittent dosing), piperacillin-tazobactam (prolonged infusion), and meropenem (prolonged infusion) concentrations. Minimum inhibitory concentration values determined using epsilometer tests of bloodstream pathogens were collected, and corresponding epidemiological cut-off values were used for target attainment calculations. The primary outcome was percentage time over minimum inhibitory concentration or four times the minimum inhibitory concentration. We used linear mixed effects models for analyzing repeated measures of continuous variables.ResultsIn total, 21 patients met the criteria for septic shock, and a total of 341 samples were analyzed (average 16 per patient). All patients achieved concentrations above the minimum inhibitory concentration for 100% of the time, and 83% of the patients achieved concentrations above 4 times the minimum inhibitory concentration for 100% of the time. We found an association between continuous renal replacement therapy and levels of antibiotics exceeding the upper therapeutic target (