Drastic Reduction of Piperacillin-Tazobactam Concentrations in an in-vitro Model of Continuous Venovenous Hemofiltration: Proposal of An Innovative Modality of Administration to Maintain them at Constant Concentration
Michele Ferrannini, Pasquale Niscola, Clorinda Falcone, Annalisa Noce, Anna Pastore, Gianna Di Giovamberardino, Andrea Tendas, Laura Scaramucci, Nicola Di Daniele and Roberto Palumbo
Affiliation: Piazzale dell’Umanesimo, 10, 00144 – Roma, Italy.
Background/Aims: Critically-ill patients often undergo continuous renal replacement therapy (CRRT) and need
antimicrobial therapy. Piperacillin and tazobactam (Pip-Tzb) are cleared by CRRT. Our aim is to evaluate Pip-Tzb
removal in an in-vitro-single-pool-model of continuous-veno-venous-hemofiltration (CVVH); we test a new method of
Pip-Tzb administration during CRRT assuring constant levels of concentrations above the minimum inhibitory
Methods: In an in-vitro-single-pool-model of CVVH, two solutions (Protein-Free-Solution, PFS and Fresh-Frozen-
Plasma, FFP) added with Pip-Tzb were tested for Pip-Tzb removal and adsorption. Then, to keep concentrations
constantly above the MIC during CVVH, we add Pip-Tzb in the reinfusion bags.
Results: Pip-Tzb rapidly decreased than the MIC during CVVH. The adsorption was irrelevant in the test with FPS.
Adding Pip-Tzb in the reinfusion bags of the CVVH system, we observed constant concentrations of Pip-Tzb over time.
Conclusion: The association of Pip-Tzb is rapidly cleared with a real risk of inadequate dosages in patients undergoing
CRRT. Adding Pip-Tzb in the reinfusion bags above the MIC, we obtained stability of concentrations during CVVH.
Keywords: Antibiotic, antimicrobial therapy, continuous renal replacement therapy, continuous venovenous hemofiltration,
drug clearance, dyalisis, in vitro investigation, infection, minimum inhibitory concentration (MIC), piperacillin, sepsis,
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