Impact of extracorporeal membrane oxygenation (ECMO) support on piperacillin exposure in septic patients: a case–control study. (11th February 2021)

• Record Type: Journal Article
• Authors: Fillâtre, P; Lemaitre, F; Nesseler, N; Schmidt, M; Besset, S; Launey, Y; Maamar, A; Daufresne, P; Flecher, E; Le Tulzo, Y; Tadie, J M; Tattevin, P
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 76:Number 5(2021)
• Page Start: 1242
• Page End: 1249
• Publication Date: 2021-02-11
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkab031
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Objectives: To describe the impact of extracorporeal membrane oxygenation (ECMO) devices on piperacillin exposure in ICU patients. Methods: This observational, prospective, multicentre, case–control study was performed in the ICUs of two tertiary care hospitals in France. ECMO patients with sepsis treated with piperacillin/tazobactam were enrolled. Control patients were matched according to SOFA score and creatinine clearance. The pharmacokinetics of piperacillin were described based on a population pharmacokinetic model, calculating the proportion of time the piperacillin plasma concentration was above 64 mg/L (i.e. 4× MIC breakpoint for Pseudomonas aeruginosa ). Results: Forty-two patients were included. Median (IQR) age was 60 years (49–66), SOFA score was 11 (9–14) and creatinine clearance was 47 mL/min (5–95). There was no significant difference in the proportion of time piperacillin concentrations were ≥64 mg/L in patients treated with ECMO and controls during the first administration ( P = 0.184) or at steady state ( P = 0.309). Following the first administration, 36/42 (86%) patients had trough piperacillin concentrations <64 mg/L. Trough concentrations at steady state were similar in patients with ECMO and controls ( P = 0.535). Creatinine clearance ≥40 mL/min was independently associated with piperacillin trough concentration <64 mg/L at steady state [OR = 4.3 (95% CI 1.1–17.7), P = 0.043], while ECMO support was not [OR = 0.5 (95% CI 0.1–2.1), P = 0.378]. Conclusions: ECMO support has no impact on piperacillin exposure. ICU patients with sepsis are frequently underexposed to piperacillin, which suggests that therapeutic drug monitoring should be strongly recommended for severe infections.