Meropenem pharmacokinetics in critically ill patients with or without burn treated with or without continuous veno-venous haemofiltration. 2022

Daniel J Selig, and Kevin S Akers, and Kevin K Chung, and Kaitlin A Pruskowski, and Jeffrey R Livezey, and Elaine D Por
Walter Reed Army Institute of Research, Experimental Therapeutics, Silver Spring, MD, United States.

Severe burn injury involves widespread skin and tissue damage leading to systemic inflammation, hypermetabolism and multi-organ failure. The hypermetabolic phase of burn injury has been associated with increased systemic antibiotic clearance; however, critical illness in the absence of burn may also induce similar physiologic changes. Continuous renal replacement therapy (CRRT) is often implemented in critically ill patients and may also affect antibiotic clearance. Although the pharmacokinetics (PK) of meropenem has been described in both the burn and non-burn critically ill populations, direct comparative data is lacking. For this study, we evaluated PK parameters of meropenem from 23 critically ill patients, burn or non-burn, treated with or without continuous veno-venous haemofiltration (CVVH) to determine the contribution of burn and CVVH to the variability of therapeutic meropenem levels. A two-compartment model best described the data and revealed creatinine clearance (CrCl) and total burn surface area (TBSA) as significant covariates on clearance (CL) and peripheral volume of distribution (Vp), respectively. Of interest, non-burn patients on CVVH displayed an overall lower inherent CL as compared to burn patients on CVVH (6.43 vs. 12.85 L/h). Probability of target attainment (PTA) simulations revealed augmented renal clearance (ARC) may necessitate dose adjustments, but TBSA and CVVH would not. We recommend a standard dose of 1000 mg every 8 hours; however, if ARC is suspected, or the severity of illness requires a more stringent therapeutic target, we recommend a loading dose of 1000-2000 mg infused over 30 minutes to 1 hour followed by continuous infusion (3000-6000 mg over 24 hours), or intermittent infusion of 2000 mg every 8 hours.

UI MeSH Term Description Entries
D002056 Burns Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Burn
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077731 Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than IMIPENEM, but does not need to be given with an enzyme inhibitor such as CILASTATIN. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. 3-(5-Dimethylcarbamoylpyrrolidin-3-ylthio)-6-(1-hydroxyethyl)-4-methyl-7-oxo-1-azabicyclo(3.2.0)hept-2-ene-2-carboxylic acid,Merrem,Penem,Ronem,SM 7338,SM-7338,SM7338
D000079664 Continuous Renal Replacement Therapy Procedures with continuous blood purification (e.g., dialysis, filtration or perfusion) via vascular access designed to mimic kidney function in kidney diseases (e.g., ACUTE RENAL FAILURE and poisoning). CAVHD,CRRT Technique,CVVH Technique,CVVHD,CVVHDF,Continuous Arterio-Venous Ultrafiltration,Continuous RRT,Continuous Renal Replacement Procedure,Continuous Veno-Venous Hemodiafiltration,Continuous Veno-Venous Hemodialysis,Continuous Veno-Venous Hemofiltration,Continuous Venovenous Hemodiafiltration,Continuous Venovenous Hemodialysis,Continuous Venovenous Hemofiltration,Hemofiltration, Continuous Arteriovenous,SCUF Technique,Slow Continuous Ultrafiltration,Arterio-Venous Ultrafiltration, Continuous,Arteriovenous Hemofiltration, Continuous,CVVH Techniques,Continuous Arterio Venous Ultrafiltration,Continuous Arterio-Venous Ultrafiltrations,Continuous Arteriovenous Hemofiltration,Continuous Arteriovenous Hemofiltrations,Continuous RRTs,Continuous Veno Venous Hemodiafiltration,Continuous Veno Venous Hemodialysis,Continuous Veno Venous Hemofiltration,Continuous Veno-Venous Hemodiafiltrations,Continuous Veno-Venous Hemodialyses,Continuous Veno-Venous Hemofiltrations,Continuous Venovenous Hemodiafiltrations,Continuous Venovenous Hemodialyses,Continuous Venovenous Hemofiltrations,Hemodiafiltration, Continuous Veno-Venous,Hemodiafiltration, Continuous Venovenous,Hemodialysis, Continuous Veno-Venous,Hemodialysis, Continuous Venovenous,Hemofiltration, Continuous Veno-Venous,Hemofiltration, Continuous Venovenous,RRT, Continuous,SCUF Techniques,Slow Continuous Ultrafiltrations,Ultrafiltration, Continuous Arterio-Venous,Veno-Venous Hemodiafiltration, Continuous,Veno-Venous Hemodialyses, Continuous,Veno-Venous Hemodialysis, Continuous,Veno-Venous Hemofiltration, Continuous,Venovenous Hemodiafiltration, Continuous,Venovenous Hemodialysis, Continuous,Venovenous Hemofiltration, Continuous
D000900 Anti-Bacterial Agents Substances that inhibit the growth or reproduction of BACTERIA. Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial
D016638 Critical Illness A disease or state in which death is possible or imminent. Critically Ill,Critical Illnesses,Illness, Critical,Illnesses, Critical
D051437 Renal Insufficiency Conditions in which the KIDNEYS perform below the normal level in the ability to remove wastes, concentrate URINE, and maintain ELECTROLYTE BALANCE; BLOOD PRESSURE; and CALCIUM metabolism. Renal insufficiency can be classified by the degree of kidney damage (as measured by the level of PROTEINURIA) and reduction in GLOMERULAR FILTRATION RATE. Kidney Insufficiency,Kidney Failure,Renal Failure,Failure, Kidney,Failure, Renal,Failures, Kidney,Failures, Renal,Insufficiency, Kidney,Kidney Failures,Kidney Insufficiencies,Renal Failures,Renal Insufficiencies

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