Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units—the SAFE-ICU study DOI Creative Commons
Jason A. Roberts, Fekade B. Sime, Jeffrey Lipman

et al.

Intensive Care Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 3, 2025

Appropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing antifungals achieves therapeutic exposures patients. In prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) prescribed azoles, echinocandins, or polyene for treatment prophylaxis disease were enrolled. Blood samples collected on two occasions, three taken during single interval each occasion. Total concentrations centrally measured using validated chromatographic methods. Pharmacokinetic parameters estimated noncompartmental Antifungal adequacy was assessed predefined PK/PD targets. included 339 from 30 ICUs across 12 countries. Median age 62 (interquartile range [IQR], 51-70) years, median APACHE II score 22 (IQR, 17-28), and 61% males. primarily (80.8%). Fluconazole the most frequently (40.7%). The common indication intra-abdominal infection (30.7%). Fungi identified 45% patients, which only 26% had minimum inhibitory concentration available. Target attainment higher receiving (> 80% drugs). For treatment, low target noted voriconazole (57.1%), posaconazole (63.2%), micafungin (64.1%) amphotericin B (41.7%). This study highlights varying degrees agents While significant proportion achieved targets, wide variability subtherapeutic persist. ClinicalTrials.gov Identifier: NCT03136926, 2017-04-21.

Language: Английский

Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units—the SAFE-ICU study DOI Creative Commons
Jason A. Roberts, Fekade B. Sime, Jeffrey Lipman

et al.

Intensive Care Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 3, 2025

Appropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing antifungals achieves therapeutic exposures patients. In prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) prescribed azoles, echinocandins, or polyene for treatment prophylaxis disease were enrolled. Blood samples collected on two occasions, three taken during single interval each occasion. Total concentrations centrally measured using validated chromatographic methods. Pharmacokinetic parameters estimated noncompartmental Antifungal adequacy was assessed predefined PK/PD targets. included 339 from 30 ICUs across 12 countries. Median age 62 (interquartile range [IQR], 51-70) years, median APACHE II score 22 (IQR, 17-28), and 61% males. primarily (80.8%). Fluconazole the most frequently (40.7%). The common indication intra-abdominal infection (30.7%). Fungi identified 45% patients, which only 26% had minimum inhibitory concentration available. Target attainment higher receiving (> 80% drugs). For treatment, low target noted voriconazole (57.1%), posaconazole (63.2%), micafungin (64.1%) amphotericin B (41.7%). This study highlights varying degrees agents While significant proportion achieved targets, wide variability subtherapeutic persist. ClinicalTrials.gov Identifier: NCT03136926, 2017-04-21.

Language: Английский

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