How to perform pharmacokinetic research of antimicrobial drugs in critically ill patients undergoing continuous renal replacement therapy : a scoping review of all relevant pharmacokinetic factors
| Title: | How to perform pharmacokinetic research of antimicrobial drugs in critically ill patients undergoing continuous renal replacement therapy : a scoping review of all relevant pharmacokinetic factors |
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| Authors: | Wieringa, Andre; Smeets, Tim J. L.; ter Horst, Peter G. J.; Hunfeld, Nicole G. M.; Bellomo, Rinaldo; Prowle, John R.; Elderman, Jan H.; Valkenburg, Abraham J.; Gommers, Diederik; Zeitlinger, Markus; Tängdén, Thomas; Abdul-Aziz, Mohd H.; Li, Jian; Sikma, Maaike A.; Mangalore, Rekha Pai; Stocker, Sophie L.; Endeman, Henrik; Koch, Birgit C. P.; Haringman, Jasper J. |
| Publisher Information: | Uppsala universitet, Infektionsmedicin; Isala Hosp, Dept Clin Pharm, Zwolle, Netherlands.;Erasmus Univ, Med Ctr, Dept Hosp Pharm, Rotterdam, Netherlands.;Erasmus Univ, Rotterdam Clin Pharmacometr Grp, Med Ctr, Rotterdam, Netherlands.; Isala Hosp, Dept Clin Pharm, Zwolle, Netherlands.;Erasmus Univ, Rotterdam Clin Pharmacometr Grp, Med Ctr, Rotterdam, Netherlands.;Erasmus Univ, Med Ctr, Dept Intens Care, Rotterdam, Netherlands.; Isala Hosp, Dept Clin Pharm, Zwolle, Netherlands.; Erasmus Univ, Med Ctr, Dept Hosp Pharm, Rotterdam, Netherlands.;Erasmus Univ, Med Ctr, Dept Intens Care, Rotterdam, Netherlands.; Austin Hosp, Dept Intens Care, Heidelberg, Vic, Australia.;Univ Melbourne, Sch Med, Dept Crit Care, Parkville, Vic, Australia.;Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia.;Royal Melbourne Hosp, Dept Intens Care, Melbourne, Vic, Australia.; Royal London Hosp, Barts Hlth Natl Hlth Serv Trust, Adult Crit Care Unit, London, England.;Queen Mary Univ London, William Harvey Res Inst, London, England.;Barts Hlth Natl Hlth Serv Trust, Royal London Hosp, Dept Renal Med & Transplantat, London, England.; Erasmus Univ, Med Ctr, Dept Intens Care, Rotterdam, Netherlands.; Isala Hosp, Dept Intens Care, Zwolle, Netherlands.; Med Univ Vienna, Dept Clin Pharmacol, Vienna, Austria.; Univ Queensland, Fac Med, Ctr Clin Res, Brisbane, Qld, Australia.; Monash Univ, Monash Biomed Discovery Inst, Infect Program, Melbourne, Vic, Australia.; Univ Utrecht, Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands.;Univ Utrecht, Univ Med Ctr Utrecht, Dutch Poisons Informat Ctr, Utrecht, Netherlands.; Alfred Hlth, Dept Infect Dis, Melbourne, Vic, Australia.;Monash Univ, Sch Translat Med, Dept Infect Dis, Melbourne, Vic, Australia.; Univ Sydney, Fac Med & Hlth, Sch Pharm, Camperdown, NSW, Australia.;St Vincents Hosp Sydney, Dept Clin Pharmacol & Toxicol, Sydney, NSW, Australia.;Univ New South Wales, Fac Med, St Vincents Clin Campus, Sydney, NSW, Australia.;Blacktown Hosp, Pharm Dept, Sydney, NSW, Australia.;Univ Sydney, Fac Med & Hlth, Sydney Musculoskeletal Hlth, Sydney, NSW, Australia.;Univ Sydney, Sydney Inst Infect Dis, Sydney, NSW, Australia.; Erasmus Univ, Med Ctr, Dept Intens Care, Rotterdam, Netherlands.;Onze Lieve Vrouw Hosp, Dept Intens Care, Amsterdam, Netherlands.; Erasmus Univ, Med Ctr, Dept Hosp Pharm, Rotterdam, Netherlands.;Erasmus Univ, Rotterdam Clin Pharmacometr Grp, Med Ctr, Rotterdam, Netherlands. |
| Publication Year: | 2026 |
| Collection: | Uppsala University: Publications (DiVA) |
| Subject Terms: | Antibiotics; Antifungal agents; Antimicrobial drugs; Antiviral agents; Continuous renal replacement therapy; Critically ill patients; ICU; Pharmacokinetics; Study design; Therapeutic drug monitoring; Anesthesiology and Intensive Care; Anestesi och intensivvård |
| Description: | Background Critically ill patients in the intensive care unit represent a highly heterogeneous population with large variations in the pharmacokinetics (PK) of antimicrobials (antibiotics, antifungals, and antiviral agents), complicating optimal dosing strategies. This becomes even more complex in those receiving continuous renal replacement therapy (CRRT), because CRRT significantly alters drug clearance. Nonetheless, many PK studies exclude patients undergoing CRRT and existing studies often suffer from methodological limitations and small sample sizes, reducing their generalizability. Accordingly, there remains a critical gap in robust, evidence-based dosing guidelines for antimicrobials in intensive care unit patients on CRRT, despite the clear clinical need. Objectives To conduct a scoping review of the literature on factors affecting the PK of antimicrobials in critically ill patients undergoing CRRT, provide practical recommendations, and develop a CRRT-PK checklist for designing and conducting PK research in this patient group. Methods Embase, Medline, and Cochrane databases, and the reference lists of relevant publications were searched from database inception to 24 June 2025. Data were extracted independently by two reviewers (AW and TJLS) and disagreements were resolved through discussion until consensus was reached. No quality appraisal was performed. Extracted data were synthesized descriptively, grouped by the type of influencing factor (CRRT-, patient-, or drug-related). Results Of 811 articles identified in the search strategy, a total of 96 articles were included in the review. All relevant CRRT-, patient-, and drug-related factors that may influence the PK of antimicrobials are discussed. Moreover, we provided practical considerations and a CRRT-PK checklist for an appropriate study design and output. Conclusions This review, along with the checklist, can form the foundation for designing and conducting high-quality PK studies in critically ill patients undergoing CRRT. By improving the ... |
| Document Type: | article in journal/newspaper |
| File Description: | application/pdf |
| Language: | English |
| Relation: | Clinical Microbiology and Infection, 1198-743X, 2026, 32:4, s. 560-571; PMID 41344569; ISI:001720575400001 |
| DOI: | 10.1016/j.cmi.2025.11.033 |
| Availability: | http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-583991; https://doi.org/10.1016/j.cmi.2025.11.033 |
| Rights: | info:eu-repo/semantics/openAccess |
| Accession Number: | edsbas.9BE2AE4F |
| Database: | BASE |