Antibacterial and antifungal drug concentrations in intra-abdominal abscesses: a prospective clinical study.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_9F0170FF7132
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Antibacterial and antifungal drug concentrations in intra-abdominal abscesses: a prospective clinical study.
Périodique
Antimicrobial agents and chemotherapy
Auteur⸱e⸱s
Cancela Costa A., Grass F., Andres Cano I., Desgranges F., Delabays C., Kritikos A., Glampedakis E., Buclin T., Duran R., Guery B., Pagani J-L, Uldry E., Decosterd L.A., Lamoth F.
ISSN
1098-6596 (Electronic)
ISSN-L
0066-4804
Statut éditorial
Publié
Date de publication
31/01/2025
Peer-reviewed
Oui
Volume
69
Numéro
1
Pages
e0117824
Langue
anglais
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Résumé
Secondary peritonitis with intra-abdominal abscesses (IAA) is difficult to treat because of the supposed low rate of penetration of antimicrobial drugs at the site of infection. However, clinical data about the actual bioavailability of antimicrobial drugs in IAA are scarce. This prospective observational study aimed at assessing the drug penetration in IAA of the antibiotics (piperacillin-tazobactam, carbapenems) and antifungals (fluconazole, echinocandins) that are usually recommended for the treatment of intra-abdominal infections. Patients with IAA who underwent a radiological or surgical drainage procedure were included. Antimicrobial drug concentrations were measured in IAA (C <sub>IAA</sub> ) and in a simultaneous plasma sample (C <sub>plasma</sub> ) to assess the C <sub>IAA</sub> /C <sub>plasma</sub> ratio. The pharmacodynamic target was defined as a C <sub>IAA</sub> equal or superior to the clinical breakpoints of susceptibility of the most relevant intra-abdominal pathogens. Clinical outcomes were assessed at hospital discharge. A total of 54 antimicrobial drug measurements were performed in 39 IAA samples originating from 36 patients. Despite important inter-individual variability, piperacillin-tazobactam exhibited the highest C <sub>IAA</sub> /C <sub>plasma</sub> ratios (median 2). The rates of target achievement were 75%-80% for piperacillin-tazobactam and meropenem but 0% for imipenem and ertapenem. These results tended to correlate with clinical outcomes (96% success rate versus 73%, respectively, P = 0.07). Among antifungals, fluconazole exhibited higher C <sub>IAA</sub> /C <sub>plasma</sub> ratios and rates of target achievement compared to echinocandins. However, no differences in clinical outcomes were observed. These results provide unique information about antimicrobial drug penetration in IAA in real clinical conditions and suggest that piperacillin-tazobactam and meropenem may have better efficacy compared to imipenem or ertapenem.
Mots-clé
Humans, Antifungal Agents/pharmacokinetics, Antifungal Agents/therapeutic use, Antifungal Agents/blood, Prospective Studies, Abdominal Abscess/drug therapy, Abdominal Abscess/microbiology, Anti-Bacterial Agents/pharmacokinetics, Anti-Bacterial Agents/therapeutic use, Male, Female, Middle Aged, Aged, Microbial Sensitivity Tests, Carbapenems/pharmacokinetics, Carbapenems/therapeutic use, Piperacillin, Tazobactam Drug Combination/therapeutic use, Piperacillin, Tazobactam Drug Combination/pharmacokinetics, Fluconazole/therapeutic use, Fluconazole/pharmacokinetics, Adult, Piperacillin/pharmacokinetics, Piperacillin/therapeutic use, Piperacillin/blood, Echinocandins/pharmacokinetics, Echinocandins/therapeutic use, Peritonitis/drug therapy, Peritonitis/microbiology, Meropenem/pharmacokinetics, Meropenem/therapeutic use, Meropenem/blood, Imipenem/pharmacokinetics, Imipenem/therapeutic use, Ertapenem/pharmacokinetics, Ertapenem/therapeutic use, beta-Lactams/pharmacokinetics, beta-Lactams/therapeutic use, anidulafungin, bioavailability, caspofungin, ertapenem, fluconazole, imipenem, meropenem, peritonitis, piperacillin, surgical
Pubmed
Web of science
Création de la notice
09/12/2024 17:19
Dernière modification de la notice
25/02/2025 8:16
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