Individual meropenem epithelial lining fluid and plasma PK/PD target attainment

It is unclear whether plasma is a reliable surrogate for target attainment in the epithelial lining fluid (ELF). The objective of this study was to characterize meropenem target attainment in plasma and ELF using prospective samples. The first 24-hour T->MIC was evaluated vs 1xMIC and 4xMIC targets at the patient (i.e., fixed MIC of 2 mg/L) and population [i.e., cumulative fraction of response (CFR) according to EUCAST MIC distributions] levels for both plasma and ELF. Among 65 patients receiving >= 24 hours of treatment, 40% of patients failed to achieve >50% T->4xMIC in plasma and ELF, and 30% of patients who achieved >50% T->4xMIC in plasma had <50% T->4xMIC in ELF. At 1xMIC and 4xMIC targets, 3% and 25% of patients with >95% T->MIC in plasma had <50% T->MIC in ELF, respectively. Those with a CRCL >115 mL/min were less likely to achieve >50%T->4xMIC in ELF (P < 0.025). In the population, CFR for Escherichia coli at 1xMIC and 4xMIC was >97%. For Pseudomonas aeruginosa, CFR was >= 90% in plasma and ranged 80%-85% in ELF at 1xMIC when a loading dose was applied. CFR was reduced in plasma (range: 75%-81%) and ELF (range: 44%-60%) in the absence of a loading dose at 1xMIC. At 4xMIC, CFR for P. aeruginosa was 60%-86% with a loading dose and 18%-62% without a loading dose. We found that plasma overestimated ELF target attainment inup to 30% of meropenem-treated patients, CRCL >115 mL/min decreased target attainment in ELF, and loading doses increased CFR in the population.

Automated summary

This study aimed to investigate the difference in target attainment of meropenem between plasma and epithelial lining fluid (ELF). The study found that some patients did not achieve the target attainment in both plasma and ELF, and those who achieved target attainment in plasma did not necessarily have the same effect in ELF. Patients with a higher creatinine clearance rate may have poorer target attainment in ELF. Additionally, the dosage and loading dose may also affect the target attainment.