Acute kidney injury is associated with abnormal cefepime exposure among critically ill children and young adults.
Background: Elevated cefepime blood concentrations can cause neurotoxicity in adults. The consequences of elevated cefepime concentrations among pediatric patients are unknown. Future exploration of such effects requires first identifying patients at risk for elevated cefepime exposure. We investiga...
| Publicado en: | Pediatric Nephrology Vol. 40; no. 2; pp. 513 - 522 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Feb2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=181827927&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 181827927 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Feb2025 vid: 40 iid: 2 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 181827927 179017261 181827927 181827927 10.1007/s00467-024-06477-4 181827927 ppf: 513 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Acute kidney injury is associated with abnormal cefepime exposure among critically ill children and young adults. aug: au: Pavia, Kathryn Girdwood, Sonya Tang Paice, Kelli Dong, Min Mizuno, Tomoyuki Tang, Peter Mangeot, Colleen Vinks, Alexander A. Kaplan, Jennifer affil: https://ror.org/01hcyya48 Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA sug: subj: Cefepime Hydrochloride Adverse Effects Cefepime Hydrochloride Adverse Effects Kidney Failure, Acute Complications Kidney Failure, Acute Drug Therapy Environmental Exposure Risk Factors Critical Illness Risk Assessment Human Retrospective Design Pediatric Care Cefepime Hydrochloride Pharmacokinetics Probability Drug Toxicity Descriptive Statistics Cefepime Hydrochloride Administration and Dosage Funding Source Child Adolescence Child, Preschool Child: 6-12 years Adolescent: 13-18 years Child, Preschool: 2-5 years ab: Background: Elevated cefepime blood concentrations can cause neurotoxicity in adults. The consequences of elevated cefepime concentrations among pediatric patients are unknown. Future exploration of such effects requires first identifying patients at risk for elevated cefepime exposure. We investigated the role of acute kidney injury as a risk factor for increased cefepime concentrations in critically ill children. Methods: This was a retrospective analysis at a single pediatric intensive care unit. Analyzed patients received at least 24 h of cefepime and had at least two opportunistic samples collected for total cefepime concentration measurement. Individual pharmacokinetic (PK) profiles during treatment courses were reconstructed using Bayesian estimation with an established population PK model. Elevated trough concentration (Cmin) was defined as ≥ 30 mg/L based on adult toxicity studies. The effect of kidney dysfunction on cefepime PK profiles was interrogated using a mixed-effect model. Results: Eighty-seven patients were included, of which 13 (14.9%) had at least one estimated Cmin ≥ 30 mg/L. Patients with elevated Cmin were more likely to have acute kidney injury (AKI) during their critical illness (92% vs. 57%, p = 0.015 for any AKI; 62% vs. 26%, p = 0.019 for severe AKI). Patients who had AKI during critical illness had significantly higher cefepime exposure, as quantified by the area under the concentration–time curve over 24 h (AUC24h) and Cmin. Conclusions: Among critically ill children, AKI is associated with elevated cefepime concentrations. Identifying these high-risk patients is the first step toward evaluating the clinical consequences of such exposures. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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