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Estimated glomerula...
Estimated glomerular filtration rate as a tool for early identification of patients with insufficient exposure to beta-lactam antibiotics in intensive care units
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- Damgaard, Tobias (author)
- Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Linköping University, Sweden:Region Kalmar County, Sweden
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- Woksepp, Hanna (author)
- Linnéuniversitetet,Institutionen för kemi och biomedicin (KOB),Region Kalmar County, Sweden,Linnaeus Univ, Sweden; Linnaeus Univ, Sweden; Linnaeus Univ, Sweden
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- Brudin, Lars (author)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Linköping University, Sweden; Region Kalmar County, Sweden
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- Bonnedahl, Jonas (author)
- Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Linköping University, Sweden:Region Kalmar County, Sweden
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- Nielsen, Elisabet I. (author)
- Uppsala University, Sweden,Uppsala Univ, Sweden
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- Schön, Thomas (author)
- Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Klinisk mikrobiologi,Region Östergötland, Infektionskliniken i Östergötland,Linköping University, Sweden;Region Kalmar County, Sweden
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- Hällgren, Anita (author)
- Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Infektionskliniken i Östergötland,Linköping University, Sweden
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(creator_code:org_t)
- 2024
- 2024
- English.
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In: Infectious Diseases. - : Taylor & Francis Group. - 2374-4235 .- 2374-4243.
- Related links:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Subject headings
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- Background: Only about 50% of intensive care unit (ICU) patients reach a free trough concentration above MIC (100% fT > MIC) of beta-lactam antibiotics. Although dose adjustments based on therapeutic drug monitoring (TDM) could be beneficial, TDM is not widely available. We investigated serum creatinine-based estimated GFR (eGFR) as a rapid screening tool to identify ICU patients at risk of insufficient exposure. Method: Ninety-three adult patients admitted to four ICUs in southeast Sweden treated with piperacillin/tazobactam, meropenem, or cefotaxime were included. Beta-lactam trough concentrations were measured. The concentration target was set to 100% fT > MICECOFF (2, 4, and 16 mg/L based on calculated free levels for meropenem, cefotaxime, and piperacillin, respectively). eGFR was primarily determined via Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and compared to three other eGFR equations. Data was analysed using logistic regression and receiver operative characteristic (ROC) curves. Results: With intermittent standard dosing, insufficient exposure was common in patients with a relative eGFR >= 48mL/min/1.73m(2) [85%, (45/53)], particularly when treated with cefotaxime [96%, (24/25)]. This eGFR cut-off had a sensitivity of 92% and specificity of 82% (AUC 0.871, p < 0.001) in identifying insufficient exposure. In contrast, patients with eGFR <48mL/min/1.73m(2) had high target attainment [90%, (36/40)] with a wide variability in drug exposure. There was no difference between the four eGFR equations (AUC 0.866-0.872, cut-offs 44-51 ml/min/1.73m(2)). Conclusion: Serum creatinine-based eGFR is a simple and widely available surrogate marker with potential for early identification of ICU patients at risk of insufficient exposure to piperacillin, meropenem, and cefotaxime.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)
Keyword
- Beta lactam
- glomerular filtration rate
- exposure
- intensive care units
- drug dose
- Medicin
- Medicine
Publication and Content Type
- ref (subject category)
- art (subject category)
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