1
|
Wijnant GJ, Ngougni Pokem P, Coessens M, Cottone E, Ermtraud J, Goeman L, Vervaeke S, Wicha SG, Van Bambeke F. Pharmacokinetics and pharmacological target attainment of standard temocillin dosing in non-critically ill patients with complicated urinary tract infections. J Antimicrob Chemother 2024:dkae215. [PMID: 38985543 DOI: 10.1093/jac/dkae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES Temocillin, a carbapenem-sparing β-lactam antibiotic, is commonly used at the standard 4 g/day dosage for treating complicated urinary tract infections (cUTIs). However, pharmacokinetic/pharmacodynamic (PK/PD) data supporting this regimen is limited. This study evaluated the plasma pharmacokinetics (PK) and PTA of temocillin in non-critically ill cUTI patients with varying degrees of renal insufficiency (RI). METHODS In this single-centre clinical study, 22 cUTI patients received a fixed 4 g/day (2 g q12h, intravenously) temocillin dose, irrespective of renal function (no RI: n = 5, mild RI: n = 8, moderate RI: n = 9). Plasma samples were collected post-dosing for LC-MS analysis of total and unbound temocillin levels. Monte Carlo simulations were performed based on the established PK/PD target of ≥35% fT > MIC (minimal inhibitory concentration). RESULTS Among patients, the highest plasma drug exposure and PK/PD target attainment were observed in those with moderate RI (median AUC0-12h = 1143 h.mg/L and %fT > MIC = 68%), followed by mild RI patients (median AUC0-12h = 918 h.mg/L and %fT > MIC = 34%), and the lowest in those with healthy kidney function (median AUC0-12h = 692 h.mg/L and %fT > MIC = 26%). Simulations indicated that the 4 g/day temocillin dose achieves 90% PTA only for glomerular filtration rate < 60 mL/min and MIC ≤ 8 mg/L. CONCLUSION The standard temocillin dose may need to be increased from 4 to 6 g/day to treat non-critically ill cUTI patients, in line with recent EUCAST recommendations. For patients with moderate RI, who experience higher exposure due to reduced renal drug clearance, 4 g/day temocillin remains appropriate.
Collapse
Affiliation(s)
- Gert-Jan Wijnant
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Marie Coessens
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Eleonora Cottone
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Julian Ermtraud
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Lieven Goeman
- Department of Urology, AZ Delta Hospital, Roeselare, Belgium
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
2
|
Deckers C, Bélik F, Denis O, Montesinos I, Bogaerts P, Boelens J, Brassinne L, Descy J, Desmet S, Gils S, Lissoir B, Magerman K, Matheeussen V, Meex C, Rodriguez Villalobos H, Van den Abeele AM, Vernelen K, Ceyssens PJ, Huang TD. Multicenter interlaboratory study of routine systems for the susceptibility testing of temocillin using a challenge panel of multidrug-resistant strains. Eur J Clin Microbiol Infect Dis 2023; 42:1477-1483. [PMID: 37870713 DOI: 10.1007/s10096-023-04681-y] [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: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
Accurate susceptibility result of temocillin (TMO) is important for treating infections caused by multidrug-resistant Enterobacterales. This multicenter study aimed to investigate the performance of routine temocillin testing assays against Enterobacterales challenging strains. Forty-seven selected clinical isolates were blindly analyzed by 12 Belgian laboratories using VITEK® 2 (n = 5) and BD Phoenix™ (n = 3) automated systems, ETEST® gradient strip (n = 3), and disk (3 brands) diffusion method (DD; n = 6) for temocillin susceptibility using standardized methodology. Results were interpreted using EUCAST 2023 criteria and compared to the broth microdilution (BMD; Sensititre™ panel) method used as gold standard. Methods' reproducibility was assessed by testing 3 reference strains in triplicate. A total of 702 organism-drug results were obtained against 33 TMO-susceptible and 14 TMO-resistant isolates. Excluding Proteae species (P. mirabilis and M. morganii), the essential agreement rates were excellent (91.5-100%) for all MIC-based methods. The highest category agreement was achieved by ETEST® (97.5%) followed by VITEK® 2 (93.2%), disk diffusion (91.6%), and BD Phoenix™ (88.5%). BD Phoenix™ and paper disk diffusion overcalled resistance (11.5% and 6.8% of major discrepancies, respectively), while ROSCO tablets diffusion and VITEK® 2 generated higher very major discrepancies (7.1% and 4.2% respectively). Inter-assay reproducibility was unsatisfactory using recommended E. coli ATCC 25922 strain but was excellent with E. coli ATCC 35218 and K. pneumoniae ATCC 700603 strains. This interlaboratory study suggests that routine testing methods provide accurate and reproducible TMO categorization results except for Proteae species.
Collapse
Affiliation(s)
- Corentin Deckers
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium.
| | - Florian Bélik
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Olivier Denis
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Isabel Montesinos
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Pierre Bogaerts
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Jerina Boelens
- Laboratory of Clinical Microbiology, UZ Gent, Ghent, Belgium
| | - Laetitia Brassinne
- Laboratory of Clinical Microbiology, Cliniques de L'Europe, Brussels, Belgium
| | - Julie Descy
- Laboratory of Clinical Microbiology, Clinique André Renard, Herstal, Belgium
| | - Stefanie Desmet
- Laboratory of Clinical Microbiology, UZ Leuven, Louvain, Belgium
| | - Sarah Gils
- Laboratory of Clinical Microbiology, Medisch Centrum Huisartsen, Louvain, Belgium
| | - Bénédicte Lissoir
- Laboratory of Clinical Microbiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Koen Magerman
- Laboratory of Clinical Microbiology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Cécile Meex
- Laboratory of Clinical Microbiology, CHU de Liège, Liège, Belgium
| | | | | | - Kris Vernelen
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | | | - Te-Din Huang
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| |
Collapse
|