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Clinical Therapeutics

Low but Sufficient Anidulafungin Exposure in Critically Ill Patients

Marjolijn J. P. van Wanrooy, Michael G. G. Rodgers, Donald R. A. Uges, Jan P. Arends, Jan G. Zijlstra, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Marjolijn J. P. van Wanrooy
aUniversity of Groningen, University Medical Center Groningen, Department of Hospital and Clinical Pharmacy, Groningen, the Netherlands
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Michael G. G. Rodgers
bUniversity of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, the Netherlands
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Donald R. A. Uges
aUniversity of Groningen, University Medical Center Groningen, Department of Hospital and Clinical Pharmacy, Groningen, the Netherlands
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Jan P. Arends
cUniversity of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands
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Jan G. Zijlstra
bUniversity of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, the Netherlands
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Tjip S. van der Werf
dUniversity of Groningen, University Medical Center Groningen, Departments of Internal Medicine and Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands
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Jos G. W. Kosterink
aUniversity of Groningen, University Medical Center Groningen, Department of Hospital and Clinical Pharmacy, Groningen, the Netherlands
eUniversity of Groningen, Department of Pharmacy, Pharmacotherapy and Pharmaceutical Care Division, Groningen, the Netherlands
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Jan-Willem C. Alffenaar
aUniversity of Groningen, University Medical Center Groningen, Department of Hospital and Clinical Pharmacy, Groningen, the Netherlands
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DOI: 10.1128/AAC.01607-13
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    FIG 1

    Mean anidulafungin concentration-time curve with standard deviations.

  • FIG 2
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    FIG 2

    AUC versus MIC for individual patients with C. albicans (a) or C. glabrata (b) infection. The line represents the ratio of the AUC of the general patient population and the EUCAST MIC breakpoint of the Candida species.

Tables

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  • TABLE 1

    Patient characteristics

    CharacteristicMedian value (IQRa)
    Age (yr)71 (60–75)
    Weight (kg)81 (72–102)
    Height (cm)175 (165–181)
    BMI (kg/m2)25.8 (23.4–36.4)
    Total body water (liter)41 (35–45)
    Underlying condition (no. of patients)
        Abdominal surgery12
        Pancreatitis3
        Infected prosthesis2
        Stomach perforation1
        Abdominal abscess1
        Pneumococcal sepsis1
    Diagnosis (no. of patients)
        Candidemia3
        Candida peritonitis13
        Candidemia and candida peritonitis4
    • ↵a IQR, interquartile range.

  • TABLE 2

    Disease severity scores and correlation with anidulafungin exposure

    ScoreMedian (IQR)Spearman correlation coefficientP value
    Apache II14 (11–15)0.0780.743
    LODS5 (3–7)0.3170.174
    MODS4 (3–8)0.3740.105
    ODIN3 (2–4)0.1500.527
    SAPS 241 (32–52)0.2020.394
    SAPS 375 (63–78)−0.0940.695
    SOFA7 (4–9)0.1530.520
  • TABLE 3

    Multiple linear regression analysis for anidulafungin exposure

    Variableβ (95% CI)aP value
    Total body water−2.566 (−4,192 to −0.941)0.004
    Total bilirubin0.232 (0.036 to 0.428)0.023
    • ↵a β, regression coefficient of the population; 95% CI, 95% confidence interval.

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Low but Sufficient Anidulafungin Exposure in Critically Ill Patients
Marjolijn J. P. van Wanrooy, Michael G. G. Rodgers, Donald R. A. Uges, Jan P. Arends, Jan G. Zijlstra, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Antimicrobial Agents and Chemotherapy Dec 2013, 58 (1) 304-308; DOI: 10.1128/AAC.01607-13

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Low but Sufficient Anidulafungin Exposure in Critically Ill Patients
Marjolijn J. P. van Wanrooy, Michael G. G. Rodgers, Donald R. A. Uges, Jan P. Arends, Jan G. Zijlstra, Tjip S. van der Werf, Jos G. W. Kosterink, Jan-Willem C. Alffenaar
Antimicrobial Agents and Chemotherapy Dec 2013, 58 (1) 304-308; DOI: 10.1128/AAC.01607-13
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