Published in:
01-12-2006 | Brief Report
Influence of renal function on trough serum concentrations of piperacillin in intensive care unit patients
Published in: Intensive Care Medicine | Issue 12/2006
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Objective
To explore the effects of renal function estimated by measured creatinine clearance (ClCR) on trough serum concentration (Cmin) of piperacillin given to critically ill patients.
Design
Prospective observational study.
Setting
An intensive care unit and research ward in a university hospital.
Patients
Seventy critically ill patients, including 22 with severe trauma.
Interventions
All subjects received an intravenous infusion of piperacillin 4 g three times (n = 61) or four times (n = 9) per day. Piperacillin Cmin values were determined 24 h after treatment started and compared to the French breakpoint defining antibiotic susceptibility against Enterobacteriaceae (8 mg/l) or Pseudomonas sp. (16 mg/l).
Results
Median (range) piperacillin Cmin was 11.9 (< 1–156.3) mg/l, with a great variability among patients. Although the median value was close to the breakpoints, sub-therapeutic plasma levels were frequently observed. Piperacillin Cmin was lower than the breakpoint for Enterobacteriaceae in 37% of patients, and lower than the breakpoint for P. aeruginosa in 67% of them. A strong relationship was observed between piperacillin Cmin and ClCR: the higher the ClCR, the lower the piperacillin Cmin in serum. For patients with a ClCR < 50 ml/min, enough piperacillin Cmin was achieved in most patients with 12 g piperacillin per day. For patients with higher ClCR values, a piperacillin daily dose of 16 g or more may be warranted.
Conclusions
In critically ill patients, therapeutic monitoring must be part of the routine, and knowledge of ClCR value may be useful for the choice of adequate initial piperacillin dosing.