Neurotoxic Concentration of Piperacillin during Continuous Infusion in Critically Ill Patients

Antimicrob Agents Chemother. 2017 Aug 24;61(9):e00654-17. doi: 10.1128/AAC.00654-17. Print 2017 Sep.

Abstract

This retrospective cohort study included 53 patients admitted to the intensive care unit (ICU), with an average age of 69 years, without neurologic disorder before initiation of a continuous piperacillin infusion at the standard dose and who underwent piperacillin serum concentration monitoring. Among them, 23 developed a neurologic disorder for which the piperacillin causality was chronologically and semiologically suggestive. A concentration threshold of 157.2 mg/liter independently predicted neurotoxicity with 96.7% specificity and 52.2% sensitivity and may constitute a limitation when targeting less susceptible pathogens.

Keywords: intensive care unit; neurotoxicity; sepsis; therapeutic drug monitoring; β-lactams.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Bacterial Agents / toxicity*
  • Critical Care / methods
  • Critical Illness
  • Drug Monitoring
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / microbiology
  • Female
  • Humans
  • Infusions, Intra-Arterial
  • Male
  • Middle Aged
  • Nervous System Diseases / chemically induced*
  • Penicillanic Acid / analogs & derivatives
  • Penicillanic Acid / therapeutic use
  • Piperacillin / administration & dosage
  • Piperacillin / therapeutic use*
  • Piperacillin / toxicity*
  • Retrospective Studies
  • Tazobactam

Substances

  • Anti-Bacterial Agents
  • Penicillanic Acid
  • Tazobactam
  • Piperacillin