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
Gianna Di Giovamberardino,
Nicola Di Daniele,
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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