Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report

β-lactams therapeutic drug monitoring (TDM) appears as an essential tool to ensure the achievement of pharmacokinetic-pharmacodynamic targets and prevent induced toxicity in intensive care unit patients. Indeed, those patients exhibit important pharmacokinetic variabilities that could lead to unpred...

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Bibliographic Details
Published inTherapie Vol. 72; no. 5; p. 587
Main Authors Toullec, Laurie, Dupouey, Julien, Vigne, Coralie, Marsot, Amélie, Allanioux, Laurent, Blin, Olivier, Leone, Marc, Guilhaumou, Romain
Format Journal Article
LanguageEnglish
Published France 01.10.2017
Subjects
Anti-Bacterial Agents - blood
Anti-Bacterial Agents - therapeutic use
Cephalosporins - blood
Cephalosporins - therapeutic use
Chromatography, High Pressure Liquid
Drug Monitoring
Humans
Intensive Care Units
Male
Middle Aged
Suivi thérapeutique pharmacologique
Therapeutic drug monitoring
Cefepime
Biological interpretation
Interférence analytique
Analytical interference
Céfépime
Interprétation biologique
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Summary:β-lactams therapeutic drug monitoring (TDM) appears as an essential tool to ensure the achievement of pharmacokinetic-pharmacodynamic targets and prevent induced toxicity in intensive care unit patients. Indeed, those patients exhibit important pharmacokinetic variabilities that could lead to unpredictable plasma concentrations, potentially associated with poor clinical outcome, development of antibiotic resistance or increased side effects. Here, we report the case of a 48-year-old-patient admitted to intensive care unit and treated by cefepime using TDM. Due to inconsistency between observed cefepime plasma concentrations and patient clinical examination, investigations were started. After analytical tests, we highlighted an underlying analytical interference that overestimated cefepime plasma concentration with our in-house high performance liquid chromatography with ultraviolet detection (HPLC-UV) method. Only the inadequacy between plasmatic concentration and patient situation alerted pharmacologists and clinicians. As we found no previous case in literature, we believe this report must serve as an example of analytical limits that required pharmacologist awareness and expertise in TDM realization.
ISSN:0040-5957
DOI:10.1016/j.therap.2017.02.003