Anesteziyoloji ve reanimasyon yoğun bakım servisinde yatan erişkin hastalarda meropenemin çukur düzeyine etki eden faktörlerin terapötik ilaç izlemi ile değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı yoğun bakım hastalarında kullanılan meropenemin çukur düzeyine (Cmin) etki eden faktörlerin saptanmasıdır. Materyal ve Metot: Bu prospektif çalışma 09.05.2022-09.03.2023 tarihleri arasında İnönü Üniversitesi Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi'nde gerçekleştirilmiştir. Yoğun bakımda yatan ve en az 48 saat meropenem tedavisi gören 18 yaşından büyük hastalar çalışmaya alındı. Meropenem tedavisinin üçüncü gününde ilaç uygulamasından yaklaşık 30 dakika önce hastadan kan alındı. Daha sonra toplanan kan santrifüj edilerek konsantrasyonları Enzyme-Linked Immuno-Sorbent Assay yöntemi ile analiz edildi. Statistical Package for the Social Sciences v27.0 kullanılarak elde edilen Cmin seviyeleri ile hastalara ait faktörler arasında istatistiksel analiz yapıldı. Bulgular: Çalışmaya 26'sı erkek olmak üzere 38 hasta dahil edildi. Hastaların yaş ortalaması 66.68±16.27 idi. En yaygın tanılar, tanımlanmamış çoklu kırıklar (%15.79), kardiyak arrest (%13.16) ve subaraknoid kanama (%10.53) idi. Meropenem Cmin düzeyleri arasında en yüksek değer 0.63 mg/L bulunmuş olup sadece bu örneğin alındığı hastaya uzatılmış infüzyon verildiği saptandı. Kreatinin klirensi eşik değeri 50 mL/dk olarak belirlendi ve ortalama Cmin seviyeleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p= 0.651). Meropenem tedavisi öncesi ve sonrası eritrosit sayısı ve hemoglobin değerlerinde anlamlı fark vardı. Bunlar meropenem tedavisinden sonra başlangıca göre azalmıştır (p<0.05). Aynı zamanda C-Reaktif Protein (CRP) ve Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) değerlerinde de çok anlamlı fark olduğu belirlendi. Meropenem tedavisi sonrası başlangıca göre CRP azalırken, SOFA skoru yükseldi (p<0.001). Cmin düzeyi ile hastalara ait bazı faktörler arasındaki ilişki incelendi ve bu faktörler ile Cmin düzeyi arasında anlamlı bir korelasyon bulunmadığı tespit edildi (p>0.05). Sonuç: Kritik hastalarda, uzun süreli beta-laktam infüzyonları Cmin düzeyini artırabilir. Terapötik ilaç izlemi bu popülasyonda tedavi etkinliğinin değerlendirilmesine yardımcı olabilir. Anahtar kelimeler: ilaç çukur düzeyi, klinik eczacılık, meropenem, terapötik ilaç izlemi, yoğun bakım ünitesi
Aim: The aim of this study is to reveal the relationship between the factors affecting the trough level (Cmin) of meropenem used in intensive care patients. Material and Method: This prospective study was carried out at İnönü University Anesthesiology and Reanimation Intensive Care Unit between 09.05.2022 and 09.03.2023. Patients over the age of 18 who were hospitalized in the intensive care unit and treated with meropenem for at least 48 hours were included in the study. On the third day of meropenem treatment, blood was drawn from the patient approximately 30 minutes before drug administration. Then, the collected blood was centrifuged, and its concentrations were analyzed by Enzyme-Linked immunosorbent Assay method. A statistical analysis was performed between the Cmin levels obtained using the Statistical Package for the Social Sciences v27.0 and the factors belonging to the patients. Results: The study included 38 patients, 26 of which were male. The mean age of the patients was 66.68±16.27. The most common diagnoses were multiple fractures, unspecified (15.79%), cardiac arrest (13.16%), and subarachnoid hemorrhage (10.53%). The highest value among the meropenem Cmin levels was found to be 0.63 mg/L, and it was determined that only the patient from whom this sample was taken was given an extended infusion. The threshold value for creatinine clearance was determined to be 50 mL/min, and there was no statistically significant difference between the groups in terms of mean Cmin levels (p= 0.651). There was a significant difference in erythrocyte count and hemoglobin values before and after meropenem treatment. These decreased after meropenem treatment compared to baseline (p<0.05). At the same time, it was determined that there was a very significant difference in C-Reactive Protein (CRP) and Sequential Organ Failure Assessment (SOFA) values. After meropenem treatment, CRP decreased and SOFA scores increased (p<0.001). The relationship between Cmin level and some factors belonging to the patients was examined and it was determined that there was no significant correlation between these factors and Cmin level (p>0.05). Conclusion: In critically ill patients, prolonged infusions of beta-lactam antibiotics may increase blood trough levels. Therapeutic drug monitoring can help evaluate treatment efficacy in this population. Keywords: clinical pharmacy, drug trough level, intensive care unit, meropenem, therapeutic drug monitoring
Aim: The aim of this study is to reveal the relationship between the factors affecting the trough level (Cmin) of meropenem used in intensive care patients. Material and Method: This prospective study was carried out at İnönü University Anesthesiology and Reanimation Intensive Care Unit between 09.05.2022 and 09.03.2023. Patients over the age of 18 who were hospitalized in the intensive care unit and treated with meropenem for at least 48 hours were included in the study. On the third day of meropenem treatment, blood was drawn from the patient approximately 30 minutes before drug administration. Then, the collected blood was centrifuged, and its concentrations were analyzed by Enzyme-Linked immunosorbent Assay method. A statistical analysis was performed between the Cmin levels obtained using the Statistical Package for the Social Sciences v27.0 and the factors belonging to the patients. Results: The study included 38 patients, 26 of which were male. The mean age of the patients was 66.68±16.27. The most common diagnoses were multiple fractures, unspecified (15.79%), cardiac arrest (13.16%), and subarachnoid hemorrhage (10.53%). The highest value among the meropenem Cmin levels was found to be 0.63 mg/L, and it was determined that only the patient from whom this sample was taken was given an extended infusion. The threshold value for creatinine clearance was determined to be 50 mL/min, and there was no statistically significant difference between the groups in terms of mean Cmin levels (p= 0.651). There was a significant difference in erythrocyte count and hemoglobin values before and after meropenem treatment. These decreased after meropenem treatment compared to baseline (p<0.05). At the same time, it was determined that there was a very significant difference in C-Reactive Protein (CRP) and Sequential Organ Failure Assessment (SOFA) values. After meropenem treatment, CRP decreased and SOFA scores increased (p<0.001). The relationship between Cmin level and some factors belonging to the patients was examined and it was determined that there was no significant correlation between these factors and Cmin level (p>0.05). Conclusion: In critically ill patients, prolonged infusions of beta-lactam antibiotics may increase blood trough levels. Therapeutic drug monitoring can help evaluate treatment efficacy in this population. Keywords: clinical pharmacy, drug trough level, intensive care unit, meropenem, therapeutic drug monitoring
Açıklama
Anahtar Kelimeler
Eczacılık ve Farmakoloji, Pharmacy and Pharmacology
