Personalized ß-lactam dosing in patients with coronavirus disease 2019 (COVID-19) and pneumonia

• Verfasst von: Chiriac, Ute [VerfasserIn]
• Verfasst von: Frey, Otto R. [VerfasserIn]
• Verfasst von: Roehr, Anka C. [VerfasserIn]
• Verfasst von: Koeberer, Andreas [VerfasserIn]
• Verfasst von: Gronau, Patrick [VerfasserIn]
• Verfasst von: Fuchs, Thomas [VerfasserIn]
• Verfasst von: Roberts, Jason A. [VerfasserIn]
• Verfasst von: Brinkmann, Alexander [VerfasserIn]
• Titel: Personalized ß-lactam dosing in patients with coronavirus disease 2019 (COVID-19) and pneumonia
• Titelzusatz: a retrospective analysis on pharmacokinetics and pharmacokinetic target attainment
• Verf.angabe: Ute Chiriac, Otto R. Frey, Anka C. Roehr, Andreas Koeberer, Patrick Gronau, Thomas Fuchs, Jason A. Roberts, Alexander Brinkmann
• Jahr: 2021
• Umfang: 7 S.
• Fussnoten: Gesehen am 30.07.2021
• Titel Quelle: Enthalten in: Medicine
• Ort Quelle: Baltimore, Md. : Lippincott Williams & Wilkins, 1922
• Jahr Quelle: 2021
• Band/Heft Quelle: 100(2021), 22, Artikel-ID e26253, Seite 1-7
• ISSN Quelle: 1536-5964
• DOI: doi:10.1097/MD.0000000000026253
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1764964349

Abstract

Pathophysiological changes are important risk factors for critically ill patients with pneumonia manifesting sub-therapeutic antibiotic exposures during empirical treatment. The effect of coronavirus disease 2019 (COVID-19) on antibiotic dosing requirements is uncertain. We aimed to determine the effect of COVID-19 on ß-lactam pharmacokinetics (PK) and PK target attainment in critically ill patients with a personalized dosing strategy. - Retrospective, single-center analysis of COVID-19 ± critically ill patients with pneumonia (community-acquired pneumonia or hospital-acquired pneumonia) who received continuous infusion of a ß-lactam antibiotic with dosing personalized through dosing software and therapeutic drug monitoring. A therapeutic exposure was defined as serum concentration between (css) 4 to 8 times the EUCAST non-species related breakpoint). - Data from 58 patients with pneumonia was analyzed. Nineteen patients were tested COVID-19-positive before the start of the antibiotic therapy for community-acquired pneumonia or hospital-acquired pneumonia. Therapeutic exposure was achieved in 71% of COVID-19 patients (68% considering all patients). All patients demonstrated css above the non-species-related breakpoint. Twenty percent exceeded css above the target range (24% of all patients). The median ß-lactam clearance was 49% compared to ß-lactam clearance in a standard patient without a significant difference regarding antibiotic, time of sampling or present COVID-19 infection. Median daily doses were 50% lower compared to standard bolus dosing. - COVID-19 did not significantly affect ß-lactam pharmacokinetics in critically ill patients. Personalized ß-lactam dosing strategies were safe in critically ill patients and lead to high PK target attainment with less resources.