prospective monitoring of cefepime in intensive care unit adult patients前瞻性监测头孢吡肟在重症监护室成人患者.pdfVIP

Chapuis et al. Critical Care 2010, 14:R51 /content/14/2/R51 R E S E A R C H Open Access Research Prospective monitoring of cefepime in intensive care unit adult patients 1,3 2 3 4 4 4 Thomas M Chapuis , Eric Giannoni , Paul A Majcherczyk , René Chioléro , Marie-Denise Schaller , Mette M Berger , Saskia Bolay3 5 3 3 , Laurent A Décosterd , Denis Bugnon and Philippe Moreillon* Abstract Introduction: Cefepime has been associated with a greater risk of mortality than other beta-lactams in patients treated for severe sepsis. Hypotheses for this failure include possible hidden side-effects (for example, neurological) or inappropriate pharmacokinetic/pharmacodynamic (PK/PD) parameters for bacteria with cefepime minimal inhibitory concentrations (MIC) at the highest limits of susceptibility (8 mg/l) or intermediate-resistance (16 mg/l) for pathogens such as Enterobacteriaceae, Pseudomonas aeruginosa and Staphylococcus aureus. We examined these issues in a prospective non-interventional study of 21 consecutive intensive care unit (ICU) adult patients treated with cefepime for nosocomial pneumonia. Methods: Patients (median age 55.1 years, range 21.8 to 81.2) received intravenous cefepime at 2 g every 12 hours for creatinine clearance (CLCr) ≥ 50 ml/min, and 2 g every 24 hours or 36 hours for CLCr 50 ml/minute. Cefepime plasma concentrations were determined at several time-points before and after drug administration by high-pressure liquid chromatography. PK/PD parameters were computed by standard non-compartmental analysis. Results: Seventeen first-doses and 11 steady states (that i