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Early β‐lactam concentrations and infectious complications after lung transplantation
Author(s) -
Taccone Fabio S.,
Bogossian Elisa G.,
Tironi Rafael M.,
Antonucci Elio,
Hites Maya,
Knoop Christiane,
Etienne Isabelle,
Jacobs Frédérique,
Creteur Jacques
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16432
Subject(s) - medicine , antibiotics , pseudomonas aeruginosa , lung transplantation , transplantation , minimum inhibitory concentration , pathogen , immunology , microbiology and biotechnology , bacteria , biology , genetics
Antibiotic underdosing in prophylactic antibiotic regimes after lung transplantation (LTx) can increase the risk of infection. We aimed to study whether β‐lactam concentrations achieved desirable pharmacodynamic targets in the early phase after LTx and the association between drug concentrations and the development of early infections or the acquisition of multidrug‐resistant (MDR) strains. We reviewed patients in whom broad‐spectrum β‐lactam levels were measured after LTx during antibiotic prophylaxis. β‐Lactam concentrations were considered “insufficient” if drug levels remained below four times the clinical breakpoint of the minimal inhibitory concentration for Pseudomonas aeruginosa . The primary outcome was the occurrence of an infection and/or acquisition of MDR pathogens in the first 14 days after transplantation. A total of 70 patients were included. “Insufficient” drug concentrations were found in 40% of patients. In 27% of patients, an early MDR pathogen was identified and 49% patients were diagnosed with an early posttransplant infection. Patients with “insufficient” drug concentrations acquired more frequently MDR bacteria and/or developed an infection than others (22/28, 79% vs. 20/42, 48% – p = .01). β‐Lactam levels were often found to be below the desired drug targets in the early phase after transplantation and may be associated with the occurrence of early infectious complications.