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MAEKAWA M, TSUKAMOTO T, TAKASAKI S, KIKUCHI M, SATO Y, OGURA J, HAYAKAWA Y, YAMAGUCHI H, MANO N. Fundamental Study of Behaviors of In-Source Collision Induced Dissociation and Shifting the Linear Range of Calibration Curves of Various Drugs and the Metabolites Used for Therapeutic Drug Monitoring. CHROMATOGRAPHY 2019. [DOI: 10.15583/jpchrom.2019.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Shinya TAKASAKI
- Department of Pharmaceutical Sciences, Tohoku University Hospital
| | - Masafumi KIKUCHI
- Department of Pharmaceutical Sciences, Tohoku University Hospital
- Graduate school of Pharmaceutical Sciences, Tohoku University
| | - Yu SATO
- Department of Pharmaceutical Sciences, Tohoku University Hospital
| | - Jiro OGURA
- Department of Pharmaceutical Sciences, Tohoku University Hospital
| | | | - Hiroaki YAMAGUCHI
- Department of Pharmaceutical Sciences, Tohoku University Hospital
- Graduate school of Pharmaceutical Sciences, Tohoku University
| | - Nariyasu MANO
- Department of Pharmaceutical Sciences, Tohoku University Hospital
- Graduate school of Pharmaceutical Sciences, Tohoku University
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52
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Dorn C, Kratzer A, Schießer S, Kees F, Wrigge H, Simon P. Determination of total or free cefazolin and metronidazole in human plasma or interstitial fluid by HPLC-UV for pharmacokinetic studies in man. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1118-1119:51-54. [DOI: 10.1016/j.jchromb.2019.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
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53
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Martens-Lobenhoffer J, Monastyrski D, Tröger U, Bode-Böger SM. Stability of meropenem in plasma versus dried blood spots (DBS). J Pharm Biomed Anal 2019; 170:279-284. [DOI: 10.1016/j.jpba.2019.03.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
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54
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Herregodts J, Van Vooren S, Deschuyteneer E, Dhaese SAM, Stove V, Verstraete AG, De Waele JJ. Measuring antibiotics in exhaled air in critically ill, non-ventilated patients: A feasibility and proof of concept study. J Crit Care 2019; 51:46-50. [PMID: 30745285 DOI: 10.1016/j.jcrc.2019.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/18/2019] [Accepted: 01/26/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Measurement of antibiotic concentrations is increasingly used to optimize antibiotic therapy. Plasma samples are typically used for this, but other matrices such as exhaled air could be an alternative. MATERIALS AND METHODS We studied 11 spontaneously breathing intensive care unit patients receiving either piperacillin/tazobactam or meropenem. Patients exhaled in the ExaBreath® device, from which the antibiotic was extracted. The presence of antibiotics was also determined in the condensate found in the device and in the plasma. RESULTS Piperacillin or meropenem could be detected in the filter in 9 patients and in the condensate in 10. Seven patients completed the procedure as prescribed. In these patients the median quantity of piperacillin in the filter was 3083 pg/filter (range 988-203,895 pg/filter), and 45 pg (range 6-126 pg) in the condensate; meropenem quantity was 21,168 pg/filter, but the quantity in the condensate was below the lower limit of quantification. There was no correlation between the concentrations in the plasma and quantities detected in the filter or condensate. CONCLUSIONS Piperacillin and meropenem can be detected and quantified in exhaled air of non-ventilated intensive care unit patients; these quantities did not correlate with plasma concentrations of these drugs.
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Affiliation(s)
- J Herregodts
- Ghent University, Department of Diagnostic Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - S Van Vooren
- Ghent University, Department of Diagnostic Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - E Deschuyteneer
- Ghent University Hospital, Dept. of Critical Care Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - S A M Dhaese
- Ghent University Hospital, Dept. of Critical Care Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - V Stove
- Ghent University, Department of Diagnostic Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - A G Verstraete
- Ghent University, Department of Diagnostic Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University Hospital, Department of Laboratory Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - J J De Waele
- Ghent University Hospital, Dept. of Critical Care Medicine, C. Heymanslaan 10, 9000 Ghent, Belgium.
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55
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Proficiency Testing for Meropenem and Piperacillin Therapeutic Drug Monitoring: Preliminary Results From the Belgian Society on Infectiology and Clinical Microbiology Pharmacokinetic-Pharmacodynamic Working Group. Ther Drug Monit 2018; 40:156-158. [PMID: 29140892 DOI: 10.1097/ftd.0000000000000467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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56
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Rawson TM, O’Hare D, Herrero P, Sharma S, Moore LSP, de Barra E, Roberts JA, Gordon AC, Hope W, Georgiou P, Cass AEG, Holmes AH. Delivering precision antimicrobial therapy through closed-loop control systems. J Antimicrob Chemother 2018; 73:835-843. [PMID: 29211877 PMCID: PMC5890674 DOI: 10.1093/jac/dkx458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Sub-optimal exposure to antimicrobial therapy is associated with poor patient outcomes and the development of antimicrobial resistance. Mechanisms for optimizing the concentration of a drug within the individual patient are under development. However, several barriers remain in realizing true individualization of therapy. These include problems with plasma drug sampling, availability of appropriate assays, and current mechanisms for dose adjustment. Biosensor technology offers a means of providing real-time monitoring of antimicrobials in a minimally invasive fashion. We report the potential for using microneedle biosensor technology as part of closed-loop control systems for the optimization of antimicrobial therapy in individual patients.
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Affiliation(s)
- T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - D O’Hare
- Department of Bioengineering, Imperial College London, London, UK
| | - P Herrero
- Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, London, UK
| | - S Sharma
- College of Engineering, Swansea University, Swansea, UK
| | - L S P Moore
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, Acton, UK
| | - E de Barra
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, Acton, UK
| | - J A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Centre for Translational Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - A C Gordon
- Section of Anaesthetics, Pain Medicine & Intensive Care, Imperial College London, London, UK
| | - W Hope
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College London, South Kensington Campus, London, UK
| | - A E G Cass
- Department of Chemistry & Institute of Biomedical Engineering, Imperial College London, Kensington Campus, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, Acton, UK
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57
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Clinical application of microsampling versus conventional sampling techniques in the quantitative bioanalysis of antibiotics: a systematic review. Bioanalysis 2018; 10:407-423. [DOI: 10.4155/bio-2017-0269] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Conventional sampling techniques for clinical pharmacokinetic studies often require the removal of large blood volumes from patients. This can result in a physiological or emotional burden, particularly for neonates or pediatric patients. Antibiotic pharmacokinetic studies are typically performed on healthy adults or general ward patients. These may not account for alterations to a patient’s pathophysiology and can lead to suboptimal treatment. Microsampling offers an important opportunity for clinical pharmacokinetic studies in vulnerable patient populations, where smaller sample volumes can be collected. This systematic review provides a description of currently available microsampling techniques and an overview of studies reporting the quantitation and validation of antibiotics using microsampling. A comparison of microsampling to conventional sampling in clinical studies is included.
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58
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Simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum using an isotope-dilution HPLC-MS/MS method. J Pharm Biomed Anal 2018; 152:102-110. [PMID: 29414000 DOI: 10.1016/j.jpba.2018.01.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to develop and validate a robust multi-analyte high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method for simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin, which are the most commonly used antibiotics in intensive care units. Sample clean-up included a protein precipitation protocol, followed by chromatographic separation on a C8 reverse phase HPLC column within 4 min, using a formic acid-ammonium formiate methanol step-elution gradient. All compounds were detected with electrospray ionization (ESI+) mass spectrometry in multiple reaction time monitoring. The method was validated according to the protocol from the European Medicines Agency and was thoroughly evaluated for interferences and quantification linearity. Linear relationships between peak area responses and drug concentrations were obtained in the range of 0.25-200 mg/l for cefepime, 0.25-120 mg/l for meropenem, 0.05-10 mg/l for ciprofloxacin, 0.125-10 mg/l for moxifloxacin, 0.125-50 mg/l for linezolid and 0.5-400 mg/l for piperacillin with an R2 > 0.997. Imprecision and inaccuracy values (both intra- and inter-assay) were ≤ 6.8% and ≤10.9% for all analytes in quality control samples, respectively. The assay proved to be selective for the study antibiotics, and the internal standards consistently compensated for matrix effects. The described simple and reliable HPLC-MS/MS assay is a powerful tool for routine TDM of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum in clinical laboratories. With a total process time of approximately 30 min, it allows for accurate and selective quantification up to the expected pharmacokinetic peak concentrations.
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59
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Le J, Poindexter B, Sullivan JE, Laughon M, Delmore P, Blackford M, Yogev R, James LP, Melloni C, Harper B, Mitchell J, Benjamin DK, Boakye-Agyeman F, Cohen-Wolkowiez M. Comparative Analysis of Ampicillin Plasma and Dried Blood Spot Pharmacokinetics in Neonates. Ther Drug Monit 2018; 40:103-108. [PMID: 29271816 PMCID: PMC5764797 DOI: 10.1097/ftd.0000000000000466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dried blood spot (DBS) is a practical sampling strategy for pharmacokinetic studies in neonates. The utility of DBS to determine the population pharmacokinetics (pop-PK) of ampicillin, as well as accuracy versus plasma samples, was evaluated. METHODS An open-label, multicenter, opportunistic, prospective study was conducted in neonates. Ampicillin concentrations from plasma and DBS (CONCPlasma and CONCDBS) were measured by liquid chromatographic tandem mass spectrometry and analyzed using pop-PK and statistical (including transformation) approaches. RESULTS A total of 29 paired plasma and DBS samples from 18 neonates were analyzed. The median (range) gestational age and postnatal age were 37 (27-41) weeks and 8 (1-26) days, respectively. The geometric mean of CONCDBS to CONCPlasma ratio was 0.56. Correlation analysis demonstrated strong association between CONCPlasma and CONCDBS (r = 0.902, analysis of variance P < 0.001). Using linear regression transformation, the estimated CONCPlasma (eCONCPlasma) was derived using (CONCDBS - 3.223)/0.51. The median bias and geometric mean ratio improved to -11% and 0.88 (Wilcoxon signed-rank test, P < 0.001), respectively, when comparing eCONCPlasma to CONCPlasma. Furthermore, using pop-PK modeling, the median bias (interquartile range) for clearance and individual predicted concentrations improved to 8% (-11 to 50) and -8% (-34 to 11), respectively, when eCONCPlasma was used. CONCLUSIONS After transformation, DBS sampling accurately predicted ampicillin exposure in neonates.
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Affiliation(s)
- Jennifer Le
- University of California, San Diego, Skaggs School of Pharmacy, CA
| | - Brenda Poindexter
- Indiana University School of Medicine, Indianapolis, IN, and Cincinnati Children's, Cincinnati, OH
| | - Janice E. Sullivan
- University of Louisville, Norton Children's Hospital and Kosair Charities Pediatric Clinical Research Unit, Louisville, KY
| | - Matthew Laughon
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Ram Yogev
- Ann and Robert H. Lurie Children's Hospital of Chicago, IL
| | - Laura P. James
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital at Little Rock, Little Rock, AR
| | - Chiara Melloni
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Daniel K. Benjamin
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Felix Boakye-Agyeman
- Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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60
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Li X, Row KH. Application of novel ternary deep eutectic solvents as a functional monomer in molecularly imprinted polymers for purification of levofloxacin. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1068-1069:56-63. [PMID: 29031109 DOI: 10.1016/j.jchromb.2017.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 01/06/2023]
Abstract
A series of ecofriendly ternary deep eutectic solvents (DESs) with different molar ratios were prepared as candidate functional monomers. Three of the optimal ternary DESs as functional monomers were applied to the preparation of molecularly imprinted polymers (MIPs). After synthesis, the proposed polymers were characterized by elemental analysis (EA), scanning electron microscopy (SEM), thermogravimetric analysis (TGA), Brunauer-Emmett-Teller surface area measurements (BET) and Fourier transform infrared spectroscopy (FT-IR). These MIPs based on ternary DESs with different molar ratios exhibited different absorption capacities of levofloxacin. A sample of levofloxacin (500ng) was dissolved in a millet extractive (10mL). All MIPs were used as SPE adsorbents to purify the extracts. According to characterization result, the ternary DES-3 (1:3:1.5) was joined in the synthetic process of MIP-1. The green ternary DES-3-based MIPs had the best selectivity recovery for levofloxacin (91.4%) from the millet extractive. The best selectivity of MIP-1 was attributed to the novel monomer (ternary DES) in the preparation of the materials. Overall, ternary DES-based MIPs have potential applications as media in many research areas.
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Affiliation(s)
- Xiaoxia Li
- Department of Chemistry and Chemical Engineering, Inha University, Incheon 402-751, Republic of Korea
| | - Kyung Ho Row
- Department of Chemistry and Chemical Engineering, Inha University, Incheon 402-751, Republic of Korea.
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61
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Toullec L, Dupouey J, Vigne C, Marsot A, Allanioux L, Blin O, Leone M, Guilhaumou R. Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report. Therapie 2017; 72:587-592. [DOI: 10.1016/j.therap.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/07/2017] [Indexed: 11/16/2022]
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Lefeuvre S, Bois-Maublanc J, Hocqueloux L, Bret L, Francia T, Eleout-Da Violante C, Billaud EM, Barbier F, Got L. A simple ultra-high-performance liquid chromatography-high resolution mass spectrometry assay for the simultaneous quantification of 15 antibiotics in plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1065-1066:50-58. [PMID: 28946125 DOI: 10.1016/j.jchromb.2017.09.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
Antibiotic (ATB) treatment of critically ill patients with pathophysiological injuries remains a challenge due to the constant increase in antimicrobial resistance. Therapeutic drug monitoring (TDM) is advised for ATB dose adjustments to avoid suboptimal concentrations and dose-related adverse effects. Therefore, a single and reliable analytical method for a broad selection of ATBs was developed using a high-resolution mass spectrometry (HRMS) platform for frequent use in intensive care units. An UHPLC assay coupled to high resolution accurate mass acquisition has been developed for the quantification of penicillins (amoxicillin, oxacillin, piperacillin, and ticarcillin), cephalosporines (cefepime, cefotaxime, ceftazidime, and ceftriaxone), carbapenems (ertapenem, imipenem, and meropenem), lincosamide (clindamycin), quinolones (ofloxacin and ciprofloxacin) and tazobactam. Plasma samples (100μL) were spiked with an internal standard solution followed by protein precipitation. Separation was achieved on an Accucore C18 column, which enabled sample analysis every 9min. All compounds were detected in electrospray positive ion mode and quantified with a linear regression between 0.5 and 32mg/L (r2>0.998). Overall precision and accuracy did not exceed 15%. No significant matrix effect was observed for the studied ATBs. Stored stock solutions at -20°C were stable for 6 months, except for amoxicillin and imipenem. Analytes in plasma were stable for 24h under ambient conditions as well as in post-preparation in an autosampler, except for amoxicillin and imipenem. This HRMS assay provides the simultaneous quantification of 15 ATB; it fulfills the usual quality criteria and was successfully applied for routine TDM of ATBs. The method is based on a full scan acquisition, and it would be easy to add other compounds to the present panel in the future, as this assay has already been proven to be efficient for different classes of compounds.
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Affiliation(s)
- S Lefeuvre
- Laboratory of Biochemistry, CHR Orléans, France.
| | | | - L Hocqueloux
- Tropical and Infectious Deseases Department, CHR Orléans, France
| | - L Bret
- Laboratory de Microbiology-Virology, CHR Orléans, France
| | - T Francia
- Laboratory of Biochemistry, CHR Orléans, France
| | | | - E M Billaud
- Pharmacology Department, AP-HP, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
| | - F Barbier
- Intensive care Department, CHR Orléans, France
| | - L Got
- Laboratory of Biochemistry, CHR Orléans, France
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63
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Simultaneous determination of nine β-lactam antibiotics in human plasma by an ultrafast hydrophilic-interaction chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1060:138-143. [PMID: 28618388 DOI: 10.1016/j.jchromb.2017.06.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/04/2017] [Accepted: 06/06/2017] [Indexed: 12/29/2022]
Abstract
Contemporary β-lactam antibiotic dosing is debatable in severely ill patients, since the occurrence of pathophysiological changes in critical illness can result in great inter-individual variability. Therapeutic drug monitoring (TDM) is a commonly used dosing strategy to optimize exposure and thereby minimize toxicity and maximize the efficacy. Currently, TDM of β-lactam antibiotics is rarely performed, due to poor availability in clinical practice. We describe an ultrafast Hydrophilic-Interaction Chromatography (HILIC) based UPLC-MS/MS method for the determination of amoxicillin, benzylpenicillin, cefotaxime, cefuroxime, ceftazidime, flucloxacillin, imipenem, meropenem and piperacillin in human plasma. This method involves simple sample preparation steps and was comprehensively validated according to standard FDA guidelines. For all analytes, mean accuracy and precision values were within the acceptance value. The lower and upper limits of quantification were found to be sufficient to cover the therapeutic range for all antibiotics. Finally, the method was successfully applied in a large pharmacokinetic study performed in the intensive care setting, and the feasibility of the analytical procedure was demonstrated in routine clinical practice. To the best of our knowledge, we report here the first HILIC-based UPLC-MS/MS assay for the determination of β-lactam antibiotics in human plasma. This simple, sensitive and ultrafast assay requires small-volume samples and can easily be implemented in clinical laboratories to promote the TDM of β-lactam antibiotics.
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Tidjani Alou M, Million M, Traore SI, Mouelhi D, Khelaifia S, Bachar D, Caputo A, Delerce J, Brah S, Alhousseini D, Sokhna C, Robert C, Diallo BA, Diallo A, Parola P, Golden M, Lagier JC, Raoult D. Gut Bacteria Missing in Severe Acute Malnutrition, Can We Identify Potential Probiotics by Culturomics? Front Microbiol 2017; 8:899. [PMID: 28588566 PMCID: PMC5440526 DOI: 10.3389/fmicb.2017.00899] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/03/2017] [Indexed: 12/22/2022] Open
Abstract
Severe acute malnutrition is the world-leading cause of children under-five's death. Recent metagenomics studies have established a link between gut microbiota and severe acute malnutrition, describing an immaturity with a striking depletion in oxygen-sensitive prokaryotes. Amoxicillin and therapeutic diet cure most of the children with severe acute malnutrition but an irreversible disruption of the gut microbiota is suspected in the refractory and most severe cases. In these cases, therapeutic diet may be unable to reverse the microbiota alteration leading to persistent impaired development or death. In addition, as enteric sepsis is a major cause of death in this context, identification of missing gut microbes to be tested as probiotics (live bacteria that confer a benefit to the host) to restore rapidly the healthy gut microbiota and prevent the gut pathogenic invasion is of foremost importance. In this study, stool samples of malnourished patients with kwashiorkor and healthy children were collected from Niger and Senegal and analyzed by culturomics and metagenomics. We found a globally decreased diversity, a decrease in the hitherto unknown diversity (new species isolation), a depletion in oxygen-sensitive prokaryotes including Methanobrevibacter smithii and an enrichment in potentially pathogenic Proteobacteria, Fusobacteria and Streptococcus gallolyticus. A complex of 12 species identified only in healthy children using culturomics and metagenomics were identified as probiotics candidates, providing a possible, defined, reproducible, safe, and convenient alternative to fecal transplantation to restore a healthy gut microbiota in malnourished children. Microbiotherapy based on selected strains has the potential to improve the current treatment of severe acute malnutrition and prevent relapse and death by reestablishing a healthy gut microbiota.
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Affiliation(s)
- Maryam Tidjani Alou
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France.,Laboratoire de Microbiologie, Département de Biologie, Université Abdou Moumouni de NiameyNiamey, Niger
| | - Matthieu Million
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Sory I Traore
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France.,Département d'Epidémiologie des Affections Parasitaires, Faculté de Médecine, Université des Sciences, des Techniques et Technologies de BamakoBamako, Mali
| | - Donia Mouelhi
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Saber Khelaifia
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Dipankar Bachar
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Aurelia Caputo
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Jeremy Delerce
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Souleymane Brah
- Service de Médecine Interne et Générale, Hôpital de NiameyNiamey, Niger
| | | | - Cheikh Sokhna
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes IRD 198, Centre National de la Recherche Scientifique 7278, Aix-Marseille UniversitéDakar, Senegal
| | - Catherine Robert
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Bouli A Diallo
- Laboratoire de Microbiologie, Département de Biologie, Université Abdou Moumouni de NiameyNiamey, Niger
| | - Aldiouma Diallo
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes IRD 198, Centre National de la Recherche Scientifique 7278, Aix-Marseille UniversitéDakar, Senegal
| | - Philippe Parola
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Michael Golden
- Department of Medicine and Therapeutics, University of AberdeenAberdeen, United Kingdom
| | - Jean-Christophe Lagier
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé Et de la Recherche Médicale 1095, IHU-Méditerranée InfectionMarseille, France
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Pinder N, Brenner T, Swoboda S, Weigand MA, Hoppe-Tichy T. Therapeutic drug monitoring of beta-lactam antibiotics - Influence of sample stability on the analysis of piperacillin, meropenem, ceftazidime and flucloxacillin by HPLC-UV. J Pharm Biomed Anal 2017; 143:86-93. [PMID: 28578254 DOI: 10.1016/j.jpba.2017.05.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/04/2017] [Accepted: 05/21/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Therapeutic drug monitoring (TDM) is a useful tool to optimize antibiotic therapy. Increasing interest in alternative dosing strategies of beta-lactam antibiotics, e.g. continuous or prolonged infusion, require a feasible analytical method for quantification of these antimicrobial agents. However, pre-analytical issues including sample handling and stability are to be considered to provide valuable analytical results. METHODS For the simultaneous determination of piperacillin, meropenem, ceftazidime and flucloxacillin, a high performance liquid chromatography (HPLC) method including protein precipitation was established utilizing ertapenem as internal standard. Long-term stability of stock solutions and plasma samples were monitored. Furthermore, whole blood stability of the analytes in heparinized blood tubes was investigated comparing storage under ambient conditions and 2-8°C. RESULTS A calibration range of 5-200μg/ml (piperacillin, ceftazidime, flucloxacillin) and 2-200μg/ml (meropenem) was linear with r2>0.999, precision and inaccuracy were <9% and <11%, respectively. The successfully validated HPLC assay was applied to clinical samples and stability investigations. At -80°C, plasma samples were stable for 9 months (piperacillin, meropenem) or 13 months (ceftazidime, flucloxacillin). Concentrations of the four beta-lactam antibiotics in whole blood tubes were found to remain within specifications for 8h when stored at 2-8°C but not at room temperature. CONCLUSIONS The presented method is a rapid and simple option for routine TDM of piperacillin, meropenem, ceftazidime and flucloxacillin. Whereas long-term storage of beta-lactam samples at -80°C is possible for at least 9 months, whole blood tubes are recommended to be kept refrigerated until analysis.
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Affiliation(s)
- Nadine Pinder
- Pharmacy Department, University Hospital Heidelberg, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany; Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Thorsten Brenner
- Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Stefanie Swoboda
- Pharmacy Department, University Hospital Heidelberg, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Torsten Hoppe-Tichy
- Pharmacy Department, University Hospital Heidelberg, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
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Martens-Lobenhoffer J, Bode-Böger SM. Quantification of meropenem in human plasma by HILIC – tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1046:13-17. [DOI: 10.1016/j.jchromb.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/05/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
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Kazemian H, Heidari H, Ghanavati R, Mohebi R, Ghafourian S, Shavalipour A, Taji A, Houri H. Characterization of Antimicrobial Resistance Pattern and Molecular Analysis among Extended Spectrum β-Lactamase-Producing Escherichia coli. PHARMACEUTICAL SCIENCES 2016. [DOI: 10.15171/ps.2016.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Zhang X, Guo F, Shao H, Zheng X. Clinical translation of polymyxin-based combination therapy: Facts, challenges and future opportunities. J Infect 2016; 74:118-130. [PMID: 27998750 DOI: 10.1016/j.jinf.2016.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/18/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
The emergence and spread of multidrug resistant Gram-negative bacteria has led to a resurgence in the clinical use of polymyxin antibiotics. However, the prevalence of polymyxin resistance is on the rise at an alarming rate, motivating the idea of combination therapy to sustain the revival of these "old" antibiotics. Although ample evidence in favor of combination therapy has emerged, it seems impracticable and confusing to find a promising combination from the diverse reports or gain adequate information on the efficacy and safety profile. With a stagnating discovery pipeline of novel antimicrobials, there is a clear need to fill the knowledge gaps in translating these basic research data to beneficial clinical practice. In this review, we examined the factors and ambiguities that stand as major hurdles in bringing polymyxin combination therapy to bedside care, highlighting the importance and urgency of incorporating translational research insights into areas of difficulty. We also discussed future research priorities that are essential to gather the necessary evidence and insights for promoting the best possible use of polymyxins in combination therapy.
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Affiliation(s)
- Xueli Zhang
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Fengmei Guo
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Hua Shao
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
| | - Xiao Zheng
- State Key Laboratory of Natural Medicines, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China.
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Guo WQ, Zheng HS, Li S, Du JS, Feng XC, Yin RL, Wu QL, Ren NQ, Chang JS. Removal of cephalosporin antibiotics 7-ACA from wastewater during the cultivation of lipid-accumulating microalgae. BIORESOURCE TECHNOLOGY 2016; 221:284-290. [PMID: 27643737 DOI: 10.1016/j.biortech.2016.09.036] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study is to evaluate the feasibility of using lipid-accumulating microalgae to remove cephalosporin antibiotics 7-amino cephalosporanic acid (7-ACA) from wastewater with the additional benefit of biofuels production. Three isolated microalgal strains (namely, Chlorella sp. Cha-01, Chlamydomonas sp. Tai-03 and Mychonastes sp. YL-02) were cultivated under 7-ACA stress and their biomass productivity, lipid production and N-NO3- consumption were monitored. It was found that 7-ACA had slight inhibition effects on the microalgal growth at the ratio of 12.0% (Cha-01), 9.6% (YL-02), 11.7% (Tai-03). However, lipid accumulation in the three microalgae was not influenced by the presence of 7-ACA. The investigation on the 7-ACA removal mechanisms during microalgal growth shows that 7-ACA was mainly removed by microalgae adsorption as well as hydrolysis and photolysis reactions. This study demonstrates that using microalgae to treat antibiotic-containing wastewater is promising due to the potential of simultaneous antibiotic removal and biofuel production.
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Affiliation(s)
- Wan-Qian Guo
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - He-Shan Zheng
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Shuo Li
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Juan-Shan Du
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Xiao-Chi Feng
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Ren-Li Yin
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Qing-Lian Wu
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Nan-Qi Ren
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China
| | - Jo-Shu Chang
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, 73 Huanghe Road, Harbin, Heilongjiang 150090, PR China; Department of Chemical Engineering, National Cheng Kung University, Tainan 701, Taiwan; Research Center for Energy Technology and Strategy Center, National Cheng Kung University, Tainan 701, Taiwan.
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[Pharmacokinetics and pharmacodynamics of antibiotics in intensive care]. Med Klin Intensivmed Notfmed 2016; 112:11-23. [PMID: 27778050 DOI: 10.1007/s00063-016-0185-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 10/20/2022]
Abstract
Optimized dosage regimens of antibiotics have remained obscure since their introduction. During the last two decades pharmacokinetic(PK)-pharmacodynamic(PD) relationships, originally established in animal experiments, have been increasingly used in patients. The action of betalactams is believed to be governed by the time the plasma concentration is above the minimum inhibitory concentration (MIC). Aminoglycosides act as planned when the peak concentration is a multiple of the MIC and vancomycin seems to work best when the area under the plasma vs. time curve (AUC) to MIC has a certain ratio. Clinicians should be aware that these relationships can only be an indication in which direction dosing should go. Larger studies with sufficiently high numbers of patients and particularly severely sick patients are needed to prove the concepts. In times where all antibiotics can be measured with new technologies, the introduction of therapeutic drug monitoring (TDM) is suggested for ICUs (Intensive Care Unit). The idea of a central lab for TDM of antibiotics such as PEAK (Paul Ehrlich Antibiotika Konzentrationsmessung) is supported.
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MONITORIZACIÓN TERAPÉUTICA DE FÁRMACOS Y ASPECTOS PRÁCTICOS DE FARMACOCINÉTICA. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Legrand T, Vodovar D, Tournier N, Khoudour N, Hulin A. Simultaneous Determination of Eight β-Lactam Antibiotics, Amoxicillin, Cefazolin, Cefepime, Cefotaxime, Ceftazidime, Cloxacillin, Oxacillin, and Piperacillin, in Human Plasma by Using Ultra-High-Performance Liquid Chromatography with Ultraviolet Detection. Antimicrob Agents Chemother 2016; 60:4734-42. [PMID: 27216076 PMCID: PMC4958196 DOI: 10.1128/aac.00176-16] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/19/2016] [Indexed: 12/18/2022] Open
Abstract
A simple and rapid ultra-high-performance liquid chromatography (UHPLC) method using UV detection was developed for the simultaneous determination of eight β-lactam antibiotics in human plasma, including four penicillins, amoxicillin (AMX), cloxacillin (CLX), oxacillin (OXA), and piperacillin (PIP), and four cephalosporins, cefazolin (CFZ), cefepime (FEP), cefotaxime (CTX), and ceftazidime (CAZ). One hundred-microliter samples were spiked with thiopental as an internal standard, and proteins were precipitated by acetonitrile containing 0.1% formic acid. Separation was achieved on a pentafluorophenyl (PFP) column with a mobile phase composed of phosphoric acid (10 mM) and acetonitrile in gradient elution mode at a flow rate of 500 μl/min. Detection was performed at 230 nm for AMX, CLX, OXA, and PIP and 260 nm for CFZ, FEP, CTX, and CAZ. The total analysis time did not exceed 13 min. The method was found to be linear at concentrations ranging from 2 to 100 mg/liter for each compound, and all validation parameters fulfilled international requirements. Between- and within-run accuracy errors ranged from -5.2% to 11.4%, and precision was lower than 14.2%. This simple method requires small-volume samples and can easily be implemented in most clinical laboratories to promote the therapeutic drug monitoring of β-lactam antibiotics. The simultaneous determination of several antibiotics considerably reduces the time to results for clinicians, which may improve treatment efficiency, especially in critically ill patients.
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Affiliation(s)
- Tiphaine Legrand
- Laboratoire de Pharmacologie-Toxicologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Dominique Vodovar
- Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France IMIV, CEA, INSERM, CNRS, Université Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France
| | - Nicolas Tournier
- IMIV, CEA, INSERM, CNRS, Université Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France
| | - Nihel Khoudour
- Laboratoire de Pharmacologie-Toxicologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Anne Hulin
- Laboratoire de Pharmacologie-Toxicologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Fridlund J, Woksepp H, Schön T. A microbiological method for determining serum levels of broad spectrum β-lactam antibiotics in critically ill patients. J Microbiol Methods 2016; 129:23-27. [PMID: 27469351 DOI: 10.1016/j.mimet.2016.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent studies show that suboptimal blood levels of β-lactam antibiotics are present in intensive care unit (ICU) patients. A common reference method for assessing drug concentrations is liquid chromatography coupled with mass-spectrometry (LC-MS) which is highly accurate but rarely available outside reference centres. Thus, our aim was to develop a microbiological method for monitoring β-lactam antibiotic serum levels which could be used at any hospital with a microbiological laboratory. METHODS The method was developed as a 96-well broth microdilution format to assess the concentrations of cefotaxime (CTX), meropenem (MER), and piperacillin (PIP). Patient serum containing antibiotics were diluted in suspensions of bacteria with known minimal inhibitory concentrations (MICs). Serum antibiotic concentrations were calculated by dividing the MIC with the dilution factor at which the serum inhibited growth of the bacterial suspension. Serum (n=88) from ICU patients at four hospitals in south-east Sweden were analysed and compared to LC-MS analysis. RESULTS The overall accuracy and precision for spiked samples and patient samples was within the pre-set target of ±20.0% for all drugs. There was a significant correlation between the microbiological assay and LC-MS for the patient samples (CTX: r=0.86, n=31; MER: r=0.96, n=11; PIP: r=0.88, n=39) and the agreement around the clinical cut-off for CTX (4.0mg/l), MER (2.0mg/l) and PIP (16.0mg/l) was 90%, 100% and 87%, respectively. CONCLUSION The microbiological method has a performance for determination of serum levels of meropenem, piperacillin and cefotaxime suitable for clinical use. It is an inexpensive method applicable in any microbiology laboratory.
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Affiliation(s)
- Jimmy Fridlund
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Hanna Woksepp
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Thomas Schön
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; Department of Medical Microbiology, Linköping University, Linköping, Sweden.
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Chang CY, Li BR, Li YK. An l-ascorbate-6-phosphate lactonase from Streptococcus pneumoniae ATCC 49136 strain reveals metallo-β-lactamase activity. Int J Antimicrob Agents 2016; 47:416-8. [DOI: 10.1016/j.ijantimicag.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 11/17/2022]
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Jager NGL, van Hest RM, Lipman J, Taccone FS, Roberts JA. Therapeutic drug monitoring of anti-infective agents in critically ill patients. Expert Rev Clin Pharmacol 2016; 9:961-79. [PMID: 27018631 DOI: 10.1586/17512433.2016.1172209] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Initial adequate anti-infective therapy is associated with significantly improved clinical outcomes for patients with severe infections. However, in critically ill patients, several pathophysiological and/or iatrogenic factors may affect the pharmacokinetics of anti-infective agents leading to suboptimal drug exposure, in particular during the early phase of therapy. Therapeutic drug monitoring (TDM) may assist to overcome this problem. We discuss the available evidence on the use of TDM in critically ill patient populations for a number of anti-infective agents, including aminoglycosides, β-lactams, glycopeptides, antifungals and antivirals. Also, we present the available evidence on the practices of anti-infective TDM and describe the potential utility of TDM to improve treatment outcome in critically ill patients with severe infections. For aminoglycosides, glycopeptides and voriconazole, beneficial effects of TDM have been established on both drug effectiveness and potential side effects. However, for other drugs, therapeutic ranges need to be further defined to optimize treatment prescription in this setting.
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Affiliation(s)
- Nynke G L Jager
- a Department of Pharmacy , Academic Medical Center , Amsterdam , The Netherlands
| | - Reinier M van Hest
- a Department of Pharmacy , Academic Medical Center , Amsterdam , The Netherlands
| | - Jeffrey Lipman
- b Burns Trauma and Critical Care Research Centre , The University of Queensland , Brisbane , Australia.,c Departments of Pharmacy and Intensive Care , Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - Fabio S Taccone
- d Department of Intensive Care, Hopital Erasme , Université Libre de Bruxelles (ULB) , Brussels , Belgium
| | - Jason A Roberts
- b Burns Trauma and Critical Care Research Centre , The University of Queensland , Brisbane , Australia.,c Departments of Pharmacy and Intensive Care , Royal Brisbane and Women's Hospital , Brisbane , Australia.,e School of Pharmacy , The University of Queensland , Brisbane , Australia
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