Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Intravenous push (IVP) administration of cefepime increases ease of preparation and limits the need for small volume parenterals. The effect on pharmacokinetic/pharmacodynamic (PK/PD) parameters is unknown, but may be more relevant for time-dependent agents like cefepime that require frequent dosing and in critically ill patients who have altered PK/PD.
Research Question or Hypothesis: IVP administration of cefepime results in decreased PK target attainment in critically ill patients with sepsis compared to historical controls receiving intravenous piggyback (IVPB) administration.
Study Design: IRB-approved, prospective, noninterventional, PK study
Methods: Hospitalized adult patients receiving cefepime were included if they had a central/midline catheter, intensive care unit length of stay =48 hours, creatinine clearance >30 mL/min without renal replacement therapy, and diagnosis of sepsis. Blood samples were obtained at cefepime steady state immediately before a dose. Serum concentrations of cefepime were measured using high-performance liquid chromatography with ultraviolet detection. Patient characteristics were collected from the electronic health record. The primary outcome was steady-state cefepime trough concentration, which was compared to a historical IVPB control and between dosing regimens using the Mann Whitney-U.
Results: Patients (n=16) had a median age of 69 years, BMI 30.6, CrCl 96 mL/min, and SOFA score 8. Ten (63%) were male and 14 (88%) had septic shock. Half of the patients received cefepime 2 g every 12 hours and half received 2 g every 8 hours. The median cefepime trough concentration was 22 mg/L (range 2–63 mg/L), which was numerically higher than a historical control in patients receiving IVPB cefepime (median trough 7 mg/L, range 2-21 mg/L). Trough concentrations were similar in patients who received cefepime at 8-hour and 12-hour intervals (25 vs 22 mg/L, p=0.959).
Conclusion: Considerable variability in trough concentrations was observed in critically ill patients with sepsis who received IVP cefepime. Methods to personalize cefepime dosing should be evaluated to optimize PK/PD in this heterogeneous population.
Presenting Author
Susan E. Smith PharmD, BCPS, BCCCP, FCCMUniversity of Georgia College of Pharmacy
Authors
Rehana Bagodiya M.S.
The University of Georgia College of Pharmacy
Michael Bartlett PhD
The University of Georgia College of Pharmacy
Christopher M. Bland Pharm.D., FCCP, FIDSA, BCPS
University of Georgia College of Pharmacy
Trisha N. Branan PharmD, BCCCP, FCCM
University of Georgia College of Pharmacy
Phuong (Josie) Luong B.S.
The University of Georgia College of Pharmacy
Nicholas Fox MD
Athens Pulmonary