Microdialysis sampling to monitor target-site vancomycin concentrations in septic infants: a feasible way to close the knowledge gap.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Publishers Country of Publication: Netherlands NLM ID: 9111860 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7913 (Electronic) Linking ISSN: 09248579 NLM ISO Abbreviation: Int J Antimicrob Agents Subsets: MEDLINE
    • Publication Information:
      Original Publication: Amsterdam : Elsevier Science Publishers, c1991-
    • Subject Terms:
      Anti-Bacterial Agents/*blood ; Drug Monitoring/*methods ; Microdialysis/*methods ; Vancomycin/*blood; Anti-Bacterial Agents/administration & dosage ; Humans ; Infant, Newborn ; Intensive Care, Neonatal/methods ; Microdialysis/adverse effects ; Sepsis/drug therapy ; Sepsis/microbiology ; Vancomycin/administration & dosage
    • Abstract:
      This work is dedicated to the memory of Hartmut Derendorf (1953-2020), a pioneer of modern pharmacokinetics and valued mentor of this project.
      Objectives: Septic infants/neonates need effective antibiotic exposure, but dosing recommendations are challenging as the pharmacokinetics in this age are highly variable. For vancomycin, which is used as a standard treatment, comprehensive pharmacokinetic knowledge especially at the infection site is lacking. Hence, an exploratory clinical study was conducted to assess the feasibility and safety of microdialysis sampling for vancomycin monitoring at the target site.
      Methods: Nine infants/neonates with therapeutic indications for vancomycin treatment were administered 15 mg/kg as 1-hour infusions every 8-24 hours. Microdialysis catheters were implanted in the subcutaneous interstitial space fluid of the lateral thigh. Samples were collected every 30 minutes over 24 hours, followed by retrodialysis for catheter calibration. Prior in vitro investigations have evaluated impact factors on relative recovery and retrodialysis.
      Results: In vitro investigations showed the applicability of microdialysis for vancomycin monitoring. Microdialysis sampling was well tolerated in all infants/neonates (23-255 days) without major bleeding or other adverse events. Pharmacokinetic profiles were obtained and showed plausible vancomycin concentration-time courses.
      Conclusions: Microdialysis as a minimally invasive technique for continuous longer-term sampling is feasible and safe in infants/neonates. Interstitial space fluid profiles were plausible and showed substantial interpatient variation. Hence, a larger microdialysis trial is warranted to further characterise the pharmacokinetics and variability of vancomycin at the target site and ultimately improve vancomycin dosing in these vulnerable patients.
      (Copyright © 2021 Elsevier Ltd. All rights reserved.)
    • Contributed Indexing:
      Keywords: Infants; Microdialysis; Therapeutic drug monitoring; Vancomycin
    • Accession Number:
      0 (Anti-Bacterial Agents)
      6Q205EH1VU (Vancomycin)
    • Publication Date:
      Date Created: 20210721 Date Completed: 20211228 Latest Revision: 20211228
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.ijantimicag.2021.106405
    • Accession Number:
      34289402