PDF(Pubmed)
Abstract：
Cefotaxime administration is recommended in doses of 3-12 g/day in adults with a Glomerular Filtration Rate (GFR) > 5 mL/min. This study aimed to assess the impact of renal function and obesity on cefotaxime concentrations in intensive care unit (ICU) patients. A retrospective cohort study was conducted on consecutive ICU patients receiving continuous cefotaxime infusion between 2020 and 2022 [IRBN992021/CHUSTE]. Doses were not constant; consequently, a concentration-to-dose ratio (C/D) was considered. Statistical analysis was performed to assess the relationship between cefotaxime concentrations, renal function, and obesity. A total of 70 patients, median age 61 years, were included, with no significant difference in cefotaxime concentrations between obese and non-obese patients. However, concentrations varied significantly by GFR, with underdosing prevalent in patients with normal to increased renal function and overdosing in those with severely impaired renal function. Adjustment of cefotaxime dosing according to GFR was associated with improved target attainment. Cefotaxime dosing in critically ill patients should consider renal function, with higher initial doses required in patients with normal to increased GFR and lower doses in those with severely impaired renal function. Therapeutic drug monitoring may aid in optimising dosing regimens. Prospective studies are warranted to validate these findings and inform clinical practice.
摘要：
对于肾小球滤过率(GFR)>5mL/min的成人,推荐以3-12g/天的剂量给予头孢噻肟。本研究旨在评估肾功能和肥胖对重症监护病房（ICU）患者头孢噻肟浓度的影响。对2020年至2022年间接受连续头孢噻肟输注的连续ICU患者进行回顾性队列研究[IRBN992021/CHUSTE]。剂量不是恒定的；因此，考虑浓度-剂量比(C/D).进行统计分析以评估头孢噻肟浓度之间的关系，肾功能,和肥胖。共有70名患者，中位年龄61岁，包括在内，肥胖和非肥胖患者的头孢噻肟浓度没有显着差异。然而,浓度因GFR而异，在肾功能正常至增加的患者中普遍用药不足，在肾功能严重受损的患者中用药过量。根据GFR调整头孢噻肟给药与改善的目标达成相关。头孢噻肟在危重患者中的剂量应考虑肾功能，GFR正常至增加的患者需要较高的初始剂量，而肾功能严重受损的患者则需要较低的剂量。治疗药物监测可以帮助优化给药方案。有必要进行前瞻性研究以验证这些发现并为临床实践提供信息。
