Suboptimal exposure to fluconazole in critically ill patients: Pharmacokinetic analysis and determinants

被引：7

作者：

Bienvenu, A. L. ^{[1
,2
]}

Pradat, P. ^{[3
]}

Matusik, E. ^{[1
]}

Piriou, V. ^{[4
]}

Rimmele, T. ^{[5
]}

Parant, F. ^{[6
]}

Tod, M. ^{[1
,7
,8
]}

Leboucher, G. ^{[1
]}

Goutelle, S. ^{[1
,7
,8
]}

机构：

[1] Hosp Civils Lyon, Serv Pharm, Grp Hosp Nord, Lyon, France

[2] Univ Lyon, ICBMS CNRS 5246, Campus Lyon Tech La Doua, Lyon, France

[3] Hosp Civils Lyon, Ctr Rech Clin, Grp Hosp Nord, Lyon, France

[4] Hosp Civils Lyon, Serv Anesthesie Reanimat, Grp Hosp Sud, Lyon, France

[5] Hosp Civils Lyon, Grp Hosp Ctr, Serv Anesthesie Reanimat, Lyon, France

[6] Hosp Civils Lyon, Lab Biochim & Biol Mol, UM Pharmacotoxicol Grp Hosp Sud, Lyon, France

[7] Univ Lyon 1, Univ Lyon, Fac Pharm Lyon, ISPB, Lyon, France

[8] Univ Lyon 1, Univ Lyon, CNRS, UMR 5558,Lab Biometrie & Biol Evolut, Villeurbanne, France

来源：

INFECTIOUS DISEASES NOW | 2023年 / 53卷 / 02期

关键词：

Antifungal stewardship; Critically ill patients; Fluconazole; Pharmacokinetic; Therapeutic drug monitoring;

D O I：

10.1016/j.idnow.2022.10.002

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: This study aims at evaluating fluconazole exposure in critically ill patients and identifying variables associated with the latter.Patients and methods: This was a 2-year (2018-2019) retrospective multicenter cohort study. Adult patients > 18 years-old with at least one fluconazole concentration measurement during their ICU stay were included.Results: Twenty patients were included. Only 11 patients had a fluconazole trough concentration (Cmin) within the target range (>= 15 mg/L). According to bivariable analysis, SOFA score, GGT, fluconazole clear-ance, Ke, and Vd, were independently associated with a decrease in fluconazole Cmin. The median loading dose required to achieve the Cmin target appeared to be greater in patients with higher SOFA or GGT level and in patients undergoing renal replacement therapy.Conclusions: This study supports recommendation for routine fluconazole therapeutic drug monitoring in ICU patients so as to avoid underexposure, especially if SOFA score is >= 7 and/or GGT is >= 100 U/L.

引用

页数：4

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