Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Betacoronavirus , Coronavirus Infections/therapy , Critical Illness/therapy , Cross Infection/prevention & control , Pandemics , Pneumonia, Ventilator-Associated/prevention & control , Pneumonia, Viral/therapy , Sepsis/prevention & control , beta-Lactams/therapeutic use , Aged , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/blood , Anti-Bacterial Agents/pharmacokinetics , Antibiotic Prophylaxis/adverse effects , COVID-19 , Cefepime/adverse effects , Cefepime/blood , Coinfection/prevention & control , Confusion/chemically induced , Confusion/etiology , Coronavirus Infections/complications , Deep Sedation , Delirium/chemically induced , Delirium/etiology , Drug Monitoring , Female , Humans , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , Pneumonia, Viral/complications , Respiration, Artificial/adverse effects , SARS-CoV-2 , beta-Lactams/adverse effects , beta-Lactams/blood , beta-Lactams/pharmacokineticsABSTRACT
ABSTRACT: Pathophysiological changes are important risk factors for critically ill patients with pneumonia manifesting sub-therapeutic antibiotic exposures during empirical treatment. The effect of coronavirus disease 2019 (COVID-19) on antibiotic dosing requirements is uncertain. We aimed to determine the effect of COVID-19 on ß-lactam pharmacokinetics (PK) and PK target attainment in critically ill patients with a personalized dosing strategy.Retrospective, single-center analysis of COVID-19â± critically ill patients with pneumonia (community-acquired pneumonia or hospital-acquired pneumonia) who received continuous infusion of a ß-lactam antibiotic with dosing personalized through dosing software and therapeutic drug monitoring. A therapeutic exposure was defined as serum concentration between (css) 4 to 8 times the EUCAST non-species related breakpoint).Data from 58 patients with pneumonia was analyzed. Nineteen patients were tested COVID-19-positive before the start of the antibiotic therapy for community-acquired pneumonia or hospital-acquired pneumonia. Therapeutic exposure was achieved in 71% of COVID-19 patients (68% considering all patients). All patients demonstrated css above the non-species-related breakpoint. Twenty percent exceeded css above the target range (24% of all patients). The median ß-lactam clearance was 49% compared to ß-lactam clearance in a standard patient without a significant difference regarding antibiotic, time of sampling or present COVID-19 infection. Median daily doses were 50% lower compared to standard bolus dosing.COVID-19 did not significantly affect ß-lactam pharmacokinetics in critically ill patients. Personalized ß-lactam dosing strategies were safe in critically ill patients and lead to high PK target attainment with less resources.