Infection

, Volume 46, Issue 2, pp 239–244 | Cite as

Beta-lactams in continuous infusion for Gram-negative bacilli osteoarticular infections: an easy method for clinical use

  • Alba Ribera
  • Laura Soldevila
  • Raul Rigo-Bonnin
  • Fe Tubau
  • Ariadna Padullés
  • Joan Gómez-Junyent
  • Javier Ariza
  • Oscar Murillo
Original Paper

Abstract

Continuous infusion (CI) of beta-lactams could optimize their pharmacokinetic/pharmacodynamic indices, especially in difficult-to-treat infections.

Purpose

To validate an easy-to-use method to guide beta-lactams dosage in CI (formula).

Methods

A retrospective analysis was conducted of a prospectively collected cohort (n = 24 patients) with osteoarticular infections caused by Gram-negative bacilli (GNB) managed with beta-lactams in CI. Beta-lactams dose was calculated using a described formula (daily dose = 24 h × beta-lactam clearance × target “steady-state” concentration) to achieve concentrations above the MIC. We correlated the predicted concentration (Cpred = daily dose/24 h × beta-lactam clearance) with the patient’s observed concentration (Cobs) measured by UPLC–MS/MS (Spearman’s coefficient).

Results

The most frequent microorganism treated was P. aeruginosa (21 cases; 9 MDR). Beta-lactams in CI were ceftazidime (n = 14), aztreonam (7), and piperacillin/tazobactam (3), mainly used in combination (12 with colistin, 5 with ciprofloxacin) and administered without notable side effects. The plasma Cobs was higher overall than Cpred; the Spearman correlation between both concentrations was rho = 0.6 (IC 95%: 0.2–0.8) for all beta-lactams, and rho = 0.8 (IC 95%: 0.4–1) for those treated with ceftazidime.

Conclusions

The formula may be useful in clinical practice for planning the initial dosage of beta-lactams in CI, while we await a systematic therapeutic drug monitoring. The use of beta-lactams in CI was safe.

Keywords

Beta-lactams Continuous infusion Biofilm-related infections Osteoarticular infections Gram-negative bacilli Antibiotic plasma levels 

Notes

Acknowledgements

We thank Michael Maudsley for helping with the English in this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

The research was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The approval was obtained from Hospital Universitari de Bellvitge Ethics Committee, a tertiary-care hospital (Barcelona).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alba Ribera
    • 1
  • Laura Soldevila
    • 1
  • Raul Rigo-Bonnin
    • 2
  • Fe Tubau
    • 3
    • 4
  • Ariadna Padullés
    • 5
  • Joan Gómez-Junyent
    • 1
  • Javier Ariza
    • 1
  • Oscar Murillo
    • 1
  1. 1.Infectious Diseases DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain
  2. 2.Clinical Laboratory DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Microbiology DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain
  4. 4.Ciber de Enfermedades Respiratorias ISCIIIMadridSpain
  5. 5.Pharmacy DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain

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