Evaluation of imipenem pharmacokinetic/pharmacodynamic parameters and
the impact on antimicrobial outcomes in critically ill patients
Abstract
Aims: Imipenem is a widely used antibiotic for the treatment of
critically ill patients with severe infections. Here, we present a
translational pharmacokinetic/pharmacodynamic mathematical model to
assess fT>MIC and evaluate the clinical outcomes of
imipenem treatment in critically ill patients. Methods: Critically ill
patients with severe infections were included in our study. Blood
samples at different time points were collected after imipenem plasma
concentration reached a steady state in vivo. A one-compartment model
was used for pharmacokinetic profiles. PK/PD parameters were calculated
separately with or without a mathematical model. Clinical results were
mainly defined as the microbiological results. The resolution of fever
and the decrease in PCT and WBC levels were also considered. Results: A
total of 54 patients were enrolled in our study. The fT>MIC
calculated by the mathematical model was 67.26±39.96%, and the
fT>MIC was 73.75±23.11% without the model. The PK/PD
parameters calculated between the two groups were not significantly
different. Regarding clinical outcomes, 35 (64.3%) patients were
defined as having clinical success. The fT>MIC was
83.33±12.90% in the clinical success group and 59.42±19.11% in the
clinical failure group. The fT>MIC was significantly
different between the two groups (p=0.022). Based on the regimens, the
PCT level decreased to at least 20% of the peak level and the WBC level
decreased during the first 3 days when patients’ fT>MIC was
greater than 70%. Conclusion: The pharmacokinetic mathematical model
may be used for PK/PD parameter evaluation. To treat critically ill
patients, achieving fT>MIC greater than 70% may be
necessary.