Article Figures & Data
Figures
- Fig. 1.
Mean concentrations of cefepime in serum with various dosage regimens during CVVH and CVVHDF. The cefepime concentrations are shown in micrograms per milliliter. The x axis represents postinfusion times. Error bars represent standard deviations.
Tables
- Table 1.
Demographic and clinical characteristics of the 12 study patients
Patient Age (yr) Ht (cm) Wt (kg) Sexa APACHE II scoreb Principal diagnosis(es) Infectious diagnosis Isolated pathogen (MIC [μg/ml]) Outcome 1 55 166 71.0 F 30 End-stage liver disease FUOc None Died 2 48 183 107.4 M 27 End-stage liver disease Pneumonia P. aeruginosa (4),Enterobacter cloacae (1) Died 3 42 169 88.4 M 25 End-stage liver disease Intra-abdominal sepsis None Survived 4 54 182 89.0 M 31 End-stage heart disease, sepsis Pneumonia None Died 5 34 168 99.9 F 23 Idiopathic thrombocytopenia purpura, respiratory failure Pneumonia Klebsiella pneumoniae (1), Moraxella catarrhalis (0.03) Survived 6 63 173 99.3 M 29 Congestive heart failure, cardiogenic shock Pneumonia Klebsiella oxytoca(0.125) Survived 7 59 178 82.2 M 24 End-stage liver disease, sepsis Intra-abdominal sepsis Escherichia coli (0.03) Died 8 41 178 133.8 M 32 Thoracic aortic dissection Pneumonia None Survived 9 33 173 108.0 F 26 End-stage heart disease FUO None Survived 10 70 204 125.3 F 29 Sepsis, rhabdomyolysis Cellulitis Group B streptococci (0.25) Survived 11 73 172 136.0 M 28 Intra-abdominal sepsis Intra-abdominal sepsis None Survived 12 52 170 82.8 M 29 Congestive heart failure, cardiogenic shock Pneumonia E. coli (0.06),Haemophilus influenzae (0.016) Survived - Table 2.
Etiologies of renal failure and details of CRRT
Patient Etiology of renal failurea Urine output/ 24 h (ml)b Type of CRRT Blood flow rate (ml/min)b Dialysis rate (ml/h)b, c, d Ultrafiltration rate (ml/min)b, d Concomitant vasoactive drug(s) 1 Ischemic ATN 0 CVVH 150 19 ± 2 Dopamine 2 ATN 2° unknown etiology 134 CVVH 150 9 ± 8 None 3 Hepatorenal syndrome 12 CVVH 150 19 ± 4 Dopamine 4 Sepsis with MODS 155 CVVH 150 15 ± 2 Dopamine, norepinephrine 5 Idiopathic thrombocytopenia purpura 35 CVVH 150 17 ± 12 None 6 Cardiogenic shock 0 CVVHDF 150 957 ± 81 18 ± 2 Dopamine, isoproteranol 7 Sepsis with MODS 29 CVVHDF 150 857 ± 227 20 ± 10 Norepinephrine 8 Ischemic ATN 0 CVVHDF 150 940 ± 28 14 ± 1 Dopamine, norepinephrine 9 ATN 2° unknown etiology 0 CVVHDF 150 954 ± 47 20 ± 4 Epinephrine 10 Rhabdomyolysis 67 CVVHDF 150 970 ± 161 23 ± 7 None 11 ATN 2° sepsis with MODS 43 CVVHDF 150 1,000 ± 0 13 ± 2 Dopamine, norepinephrine 12 Cardiogenic shock 0 CVVHDF 150 1,020 ± 26 14 ± 2 Dopamine, epinephrine - Table 3.
Summary of cefepime pharmacokinetic parameters for patients receiving CVVH
Patient Dosing regimen Cmax(μg/ml) Cmin(μg/ml) AUC0–24(μg · h/ml) t1/2 (h) V (liter/kg) CLS UFRa (ml/min) CRRT CLb Sb ml/min ml/min/kg ml/min ml/min/kg %CLS 1 2 g every 24 h 61.6 18.7 943.5 13.7 0.64 38 ± 6 0.54 ± 0.08 19 ± 2 16 ± 4 0.23 ± 0.05 42 ± 3 0.92 ± 0.07 2 2 g every 24 h 67.4 13.5 1,050.9 10.2 0.36 44 ± 4 0.41 ± 0.04 9 ± 8 3 ± 2 0.03 ± 0.02 8 ± 4 0.84 ± 0.05 3 2 g every 24 h 86.4 20.7 1,258.4 11.4 0.38 33 ± 4 0.38 ± 0.04 19 ± 4 17 ± 3 0.19 ± 0.04 29 ± 19 0.89 ± 0.08 4 1 g every 12 h 44.6 27.9 834.7 17.0 0.43 28 ± 3 0.29 ± 0.03 15 ± 2 13 ± 3 0.13 ± 0.03 45 ± 14 0.81 ± 0.13 5 2 g every 12 h 94.9 48.0 1,677.8 12.2 0.38 35 ± 1 0.36 ± 0.01 17 ± 12 14 ± 10 0.14 ± 0.10 39 ± 28 0.83 ± 0.11 Mean ± SD 12.9 ± 2.6 0.46 ± 0.14 36 ± 6c 0.40 ± 0.09c 16 ± 4a 13 ± 4a 0.15 ± 0.06c 40 ± 16c 0.86 ± 0.04c ↵a UFR, ultrafiltration rate.
↵b Values are means ± standard deviations calculated from parameter values determined during each of the four or five postdose sampling intervals for each patient: 1 to 2 h, 2 to 4 h, 4 to 8 h, 8 to 12 h, and 12 to 24 h (except with 12-h dosing interval regimens).
↵c Means ± standard deviations calculated from means of the four or five parameter values determined for each individual patient.
- Table 4.
Summary of cefepime pharmacokinetic parameters for patients receiving CVVHDF
Patient Dosing regimen Cmax(μg/ml) Cmin(μg/ml) AUC0–24(μg · h/ml) t1/2 (h) V (liter/kg) CLS UFRa (ml/min) CRRT CLb Sab ml/min ml/min/kg ml/min ml/min/kg %CLS 6 1 g every 24 h 44.8 5.8 600.7 8.0 0.30 38 ± 4 0.44 ± 0.04 18 ± 2 25 ± 6 0.28 ± 0.07 33 ± 10 0.73 ± 0.09 7 1 g every 24 h 25.7 3.5 344.9 8.2 0.58 67 ± 5 0.81 ± 0.06 20 ± 10 23 ± 8 0.27 ± 0.10 66 ± 18 0.65 ± 0.09 8 1 g every 12 h 36.2 13.6 581.8 8.3 0.35 58 ± 1 0.49 ± 0.01 14 ± 1 28 ± 1 0.24 ± 0.02 48 ± 1 0.92 ± 0.02 9 2 g every 24 h 72.9 10.4 979.2 8.4 0.32 26 ± 6 0.24 ± 0.06 20 ± 4 47 ± 5 0.44 ± 0.05 56 ± 14 0.73 ± 0.12 10 2 g every 24 h 79.1 6.9 1,009.9 6.7 0.21 36 ± 8 0.30 ± 0.07 23 ± 7 45 ± 2 0.37 ± 0.01 81 ± 19 0.93 ± 0.06 11 2 g every 24 h 63.6 12.2 890.9 9.9 0.26 23 ± 2 0.17 ± 0.01 13 ± 2 42 ± 1 0.31 ± 0.01 53 ± 4 0.78 ± 0.07 12 2 g every 24 h 90.8 20.4 1,306.8 10.9 0.34 22 ± 1 0.27 ± 0.02 14 ± 2 30 ± 1 0.36 ± 0.01 76 ± 4 0.75 ± 0.05 Mean ± SD 8.6 ± 1.4 0.34 ± 0.12 47 ± 0.12c 0.46 ± 0.17c 17 ± 4c 26 ± 5c 0.25 ± 0.04c 59 ± 16c 0.78 ± 0.10c ↵a UFR, ultrafiltration rate.
↵b Values are means ± standard deviations calculated from parameter values determined during each of the four or five postdose sampling intervals for each patient: 1 to 2 h, 2 to 4 h, 4 to 8 h, 8 to 12 h, and 12 to 24 h (except with 12-h dosing interval regimens).
↵c Means ± standard deviations calculated from means of the four or five parameter values determined for each individual patient.
- Table 5.
Calculated pharmacodynamic parameters for cefepime with various dosage regimens during CRRT
Pharmacodynamic parameter Parameter value by different dosage regimens and treatments 1 g every 24 h 1 g every 12 h 2 g every 24 h 2 g every 12 h CVVH CVVHDF (n = 2) CVVH (n = 1) CVVHDF (n = 1) CVVH (n = 3) CVVHDF (n = 4) CVVH (n = 1) CVVHDF T > MIC NAa NA MIC ≤ 4 μg/ml NA 100% 100% 100% 100% 100% 100% NA MIC = 8 μg/ml NA 74% 100% 100% 100% 100% 100% NA MIC = 16 μg/ml NA 40% 100% 85% 100% 84% 100% NA AUC0–24/MIC MIC ≤ 4 μg/ml NA 118 209 145 263 262 419 NA MIC = 8 μg/ml NA 59 104 73 131 131 210 NA MIC = 16 μg/ml NA 30 52 36 66 65 105 NA ↵a NA, not available (dosage regimens not studied).
