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Báo cáo y học: "Insufficient β-lactam concentrations in the early phase of severe sepsis and septic shock"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Insufficient β-lactam concentrations in the early phase of severe sepsis and septic shock. | Taccone et al. Critical Care 2010 14 R126 http ccforum.eom content 14 4 R126 c CRITICAL CARE RESEARCH Open Access Insufficient p-lactam concentrations in the early phase of severe sepsis and septic shock Fabio Silvio Taccone1 Pierre-Francois Laterre2 Thierry Dugernier3 Herbert Spapen4 Isabelle Delattre5 Xavier Wittebole2 Daniel De Backer1 Brice Layeux6 Pierre Wallemacq5 Jean-Louis Vincent1 and Frederique Jacobs 6 Abstract Introduction Altered pharmacokinetics PK in critically ill patients can result in insufficient serum p-lactam concentrations when standard dosages are administered. Previous studies on p-lactam PK have generally excluded the most severely ill patients or were conducted during the steady-state period of treatment. The aim of our study was to determine whether the first dose of piperacillin-tazobactam ceftazidime cefepime and meropenem would result in adequate serum drug concentrations in patients with severe sepsis and septic shock. Methods Open prospective multicenter study in four Belgian intensive care units. All consecutive patients with a diagnosis of severe sepsis or septic shock in whom treatment with the study drugs was indicated were included. Serum concentrations of the antibiotics were determined by high-pressure liquid chromatography HPLC before and 1 1.5 4.5 and 6 or 8 hours after administration. Results 80 patients were treated with piperacillin-tazobactam n 27 ceftazidime n 18 cefepime n 19 or meropenem n 16 . Serum concentrations remained above 4 times the minimal inhibitory concentration T 4 X MIC corresponding to the clinical breakpoint for Pseudomonas aeruginosa defined by the European Committee on Antimicrobial Susceptibility Testing EUCAST for 57 of the dosage interval for meropenem target MIC 8 pg mL 45 for ceftazidime MIC 32 pg mL 34 for cefepime MIC 32 pg mL and 33 for piperacillin-tazobactam MIC 64 pg mL . The number of patients who attained the target PK profile was 12 16 for meropenem 75 5 18 for ceftazidime 28 3 19 16 .