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Metsu D, Cinq-Frais C, Camare C, Caspar-Bauguil S, Galinier A. Zinc unbound concentration as an anchor to drive individualize repletion. Clin Nutr 2024; 43:1021-1023. [PMID: 38513551 DOI: 10.1016/j.clnu.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Zinc (Zn) quantification is of particular interest in many clinical condition (e.g. inflammatory disease, critical care). Currently, Zn status is assessed by measuring plasma/serum concentration. This concentration corresponds to the sum of unbound Zn (Zn-Cu) and Zn highly bound to albumin (Zn-Cb). METHODS Using a pharmacokinetic approach to the interpretation of total Zn concentration (Zn-Ct), taking into account Zn-Cu and the influence of hypoalbuminemia on Zn-Cb, it is possible to improve the individualization of Zn repletion. RESULTS Therefore, during pregnancy and in certain inflammatory disease situations, repletion may not be necessary. However, as in critical care, it would be more appropriate to perform Zn-Cu assays to improve Zn repletion. CONCLUSION Coupled total and unbound Zn should be monitored in order to individualize Zn repletion.
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Affiliation(s)
- D Metsu
- Department of Clinical Laboratory, Montauban Hospital, Montauban, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), Equipe MetaDiab, University of Toulouse, INSERM, University of Toulouse III - Paul Sabatier (UPS), Toulouse, France.
| | - C Cinq-Frais
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France
| | - C Camare
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France; Institute for Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, INSERM, University of Toulouse III - Paul Sabatier (UPS), 31432 Toulouse, France
| | - S Caspar-Bauguil
- Institute of Metabolic and Cardiovascular Diseases (I2MC), Equipe MetaDiab, University of Toulouse, INSERM, University of Toulouse III - Paul Sabatier (UPS), Toulouse, France; Department of Biochemistry, Toulouse University Hospital, Toulouse, France
| | - A Galinier
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France; Institut RESTORE, UMR 1301 INSERM, 5070 CNRS, Université Paul Sabatier, Toulouse, France
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Herrera-Hidalgo L, Muñoz P, Álvarez-Uría A, Alonso-Menchén D, Luque-Marquez R, Gutiérrez-Carretero E, Fariñas MDC, Miró JM, Goenaga MA, López-Cortés LE, Angulo-Lara B, Boix-Palop L, de Alarcón A. Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort. Int J Infect Dis 2023; 137:134-143. [PMID: 37926195 DOI: 10.1016/j.ijid.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). METHODS Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. RESULTS We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. CONCLUSION Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective.
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Affiliation(s)
- Laura Herrera-Hidalgo
- Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain; Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain; Biomedical Research Centre Network for Respiratory Diseases-CIBERES, Madrid, Spain
| | - Ana Álvarez-Uría
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Rafael Luque-Marquez
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Encarnación Gutiérrez-Carretero
- Department of Cardiac Surgery, Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío Seville, Spain; Biomedical Research Centre Network for Cardiovascular Diseases-CIBERCV, Madrid, Spain
| | - María Del Carmen Fariñas
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department Servicio de of Infectious Diseases, Health Research Institute Valdecilla (IDIVAL), University Hospital Universitario Marqués de Valdecilla/ University of Cantabria, Santander
| | - Jose Maria Miró
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases. Hospital Clínic/ Biomedical Research Institute August Pi i Sunyer (IDIBAPS)/ University of Barcelona, Barcelona, Spain
| | - Miguel Angel Goenaga
- Department of Infectious Diseases, Donosti Hospital, Donostia-San Sebastian, Spain
| | - Luis Eduardo López-Cortés
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases and Microbiology Clinical, University Hospital Virgen Macarena, Sevilla, Spain; Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - Basilio Angulo-Lara
- Department of Cardiology, University Hospital Puerta del Hierro, Madrid, Spain
| | - Lucia Boix-Palop
- Department of Infectious Diseases, University Hospital Mútua Terrassa, Barcelona, Spain
| | - Arístides de Alarcón
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Hodiamont CJ, van den Broek AK, de Vroom SL, Prins JM, Mathôt RAA, van Hest RM. Clinical Pharmacokinetics of Gentamicin in Various Patient Populations and Consequences for Optimal Dosing for Gram-Negative Infections: An Updated Review. Clin Pharmacokinet 2022; 61:1075-1094. [PMID: 35754071 PMCID: PMC9349143 DOI: 10.1007/s40262-022-01143-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/04/2022]
Abstract
Gentamicin is an aminoglycoside antibiotic with a small therapeutic window that is currently used primarily as part of short-term empirical combination therapy. Gentamicin dosing schemes still need refinement, especially for subpopulations where pharmacokinetics can differ from pharmacokinetics in the general adult population: obese patients, critically ill patients, paediatric patients, neonates, elderly patients and patients on dialysis. This review summarizes the clinical pharmacokinetics of gentamicin in these patient populations and the consequences for optimal dosing of gentamicin for infections caused by Gram-negative bacteria, highlighting new insights from the last 10 years. In this period, several new population pharmacokinetic studies have focused on these subpopulations, providing insights into the typical values of the most relevant pharmacokinetic parameters, the variability of these parameters and possible explanations for this variability, although unexplained variability often remains high. Both dosing schemes and pharmacokinetic/pharmacodynamic (PK/PD) targets varied widely between these studies. A gentamicin starting dose of 7 mg/kg based on total body weight (or on adjusted body weight in obese patients) appears to be the optimal strategy for increasing the probability of target attainment (PTA) after the first administration for the most commonly used PK/PD targets in adults and children older than 1 month, including critically ill patients. However, evidence that increasing the PTA results in higher efficacy is lacking; no studies were identified that show a correlation between estimated or predicted PK/PD target attainment and clinical success. Although it is unclear if performing therapeutic drug monitoring (TDM) for optimization of the PTA is of clinical value, it is recommended in patients with highly variable pharmacokinetics, including patients from all subpopulations that are critically ill (such as elderly, children and neonates) and patients on intermittent haemodialysis. In addition, TDM for optimization of the dosing interval, targeting a trough concentration of at least < 2 mg/L but preferably < 0.5–1 mg/L, has proven to reduce nephrotoxicity and is therefore recommended in all patients receiving more than one dose of gentamicin. The usefulness of the daily area under the plasma concentration–time curve for predicting nephrotoxicity should be further investigated. Additionally, more research is needed on the optimal PK/PD targets for efficacy in the clinical situations in which gentamicin is currently used, that is, as monotherapy for urinary tract infections or as part of short-term combination therapy.
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Affiliation(s)
- Caspar J Hodiamont
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Annemieke K van den Broek
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne L de Vroom
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Reinier M van Hest
- Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Descombes E, Hemett OM, Erard V, Chuard C. Comment on: "Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Haemodialysis". Drugs 2021; 81:1121-1123. [PMID: 34037962 DOI: 10.1007/s40265-021-01535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Eric Descombes
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Route de Bertigny, 1708, Fribourg, Switzerland.
| | - Ould Maouloud Hemett
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Route de Bertigny, 1708, Fribourg, Switzerland
| | - Véronique Erard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
| | - Christian Chuard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
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