Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia
Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia
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DOI：
10.1097/01.ccm.0000069734.38738.c8
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发表时间：
2003-08-01
影响因子：
8.8
通讯作者：
Allaouchiche, B
中科院分区：
文献类型：
--
作者：
Boselli, E;Breilh, D;Allaouchiche, B
客观的。旨在确定患有严重细菌性肺炎的危重患者连续输注头孢吡肟的稳态血浆和上皮衬里液浓度。设计：前瞻性、开放标签研究。设置：大学医院的重症监护室和研究病房。患者。纳入 20 名需要机械通气的严重院内细菌性肺炎成人患者。干预措施。所有受试者均接受 30 分钟静脉输注头孢吡肟 2 g，然后在 24 小时内连续输注 4 g。治疗48小时后，用高效液相色谱法测定稳态下血浆和上皮衬里液中头孢吡肟的浓度。测量和主要结果。连续输注头孢吡肟 4 g 的平均+/-SD稳态血浆和上皮衬里液浓度分别为 13.5 +/- 3.3 mug/mL 和 14.1+/-2.8 mug/mL，头孢吡肟进入上皮衬里液的平均渗透百分比约为 100%。 结论：在患有严重院内感染的危重患者中连续输注 4 g 头孢吡肟肺炎似乎通过在治疗过程中在血清和上皮衬里液中不断提供超过大多数易感生物体的最低抑制浓度的浓度来优化这种β-内酰胺的药效学特征。
Objective. To determine the steady-state plasma and epithelial lining fluid concentrations of cefepime administered in continuous infusion in critically ill patients with severe bacterial pneumonia.Design: Prospective, open-label study.Setting: An intensive care unit and research ward in a university hospital.Patients. Twenty adult patients with severe nosocomial bacterial pneumonia on mechanical ventilation were enrolled.Interventions. All subjects received a 30-min intravenous infusion of cefepime 2 g followed by a continuous infusion of 4 g over 24 hrs. The concentrations of cefepime in plasma and epithelial lining fluid were determined at steady state after 48 hrs of therapy with high performance liquid chromatography.Measurements and Main Results. The mean +/- SD steady-state plasma and epithelial lining fluid concentrations of cefepime 4 g in continuous infusion were 13.5 +/- 3.3 mug/mL and 14.1 +/- 2.8 mug/mL, respectively, with a mean percentage penetration of cefepime into epithelial lining fluid of about 100%.Conclusions: The administration of 4 g of cefepime in continuous infusion in critically ill patients with severe nosocomial pneumonia appears to optimize the pharmacodynamic profile of this beta-lactam by constantly providing concentrations in excess of minimal inhibitory concentration of most of susceptible organisms over the course of therapy in both serum and epithelial lining fluid.