ABSTRACT

Introduction: Critically ill patients with acute kidney injury often require renal replacement therapy and antibiotic therapy. Mortality rates are high in these patients, possibly due to ineffective dosing due to altered pharmacokinetic profiles and drug removal by renal replacement therapy.

Areas covered: The main types of renal replacement therapies are intermittent hemodialysis, prolonged intermittent renal replacement therapy and continuous renal replacement therapy. Each of these renal replacement therapies may have drastic, yet different, effects on antibiotic serum concentration profiles. Moreover, three antibiotic administration strategies are often used: (1) standard infusion; (2) extended infusion; and (3) continuous infusion. A literature review was conducted on Medline in December 2019 to identify pertinent research.

Expert opinion: Renal replacement therapies used in the treatment of acute kidney injury in critically ill patients usually complicates antibiotic use. Although antibiotic toxicity can be seen, most studies find that these patients do not receive sufficient antibiotic doses to achieve desired pharmacodynamic targets. Clinicians should dose antibiotics to match renal replacement therapy drug clearance characteristics to antibiotic pharmacodynamic profiles.

摘要

简介：患有急性肾损伤的重症患者通常需要肾脏替代治疗和抗生素治疗。这些患者的死亡率很高，这可能是由于药代动力学特征改变和通过肾脏替代疗法去除药物引起的无效剂量。

涵盖的领域：肾脏替代疗法的主要类型是间歇性血液透析，长期间歇性肾脏替代疗法和连续性肾脏替代疗法。这些肾脏替代疗法中的每一种都可能对抗生素血清浓度曲线产生巨大但不同的影响。而且，经常使用三种抗生素施用策略：（1）标准输注；（2）延长输液时间；（3）连续输注。为了确定相关研究，于2019年12月在Medline进行了文献综述。

专家意见：用于治疗重症患者的急性肾损伤的肾脏替代疗法通常会使抗生素的使用复杂化。尽管可以看到抗生素的毒性，但大多数研究发现这些患者未接受足够的抗生素剂量以达到所需的药效学指标。临床医生应给抗生素剂量，以使肾脏替代疗法的药物清除特征与抗生素药效学特征相匹配。