Steady-state plasma and intrapulmonary concentrations of... : Critical Care Medicine (original) (raw)

CLINICAL INVESTIGATIONS

Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion in critically ill patients with severe nosocomial pneumonia*

Boselli, Emmanuel MD; Breilh, Dominique PharmD; Duflo, Frédéric MD; Saux, Marie-Claude PharmD; Debon, Richard MD; Chassard, Dominique MD; Allaouchiche, Bernard MD

From the Department of Anesthesiology and Intensive Care (EB, FD, RD, DC, BA), Hôtel-Dieu Hospital, Lyon, France; and the Clinical Pharmacokinetic Laboratory (DB, M-CS), Haut-Lévêque Hospital, University of Bordeaux II, Bordeaux, France

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 β-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.

* See also p. 2242.

Abstract

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 μg/mL and 14.1 ± 2.8 μg/mL, respectively, with a mean percentage penetration of cefepime into epithelial lining fluid of about 100%.