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Are standard doses of piperacillin sufficient for critically ill patients with augmented creatinine clearance?

Overview of attention for article published in Critical Care, December 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (91st percentile)
  • High Attention Score compared to outputs of the same age and source (97th percentile)

Mentioned by

blogs
1 blog
twitter
14 tweeters

Citations

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95 Dimensions

Readers on

mendeley
102 Mendeley
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Title
Are standard doses of piperacillin sufficient for critically ill patients with augmented creatinine clearance?
Published in
Critical Care, December 2015
DOI 10.1186/s13054-015-0750-y
Pubmed ID
Authors

Andrew A Udy, Jeffrey Lipman, Paul Jarrett, Kerenaftali Klein, Steven C Wallis, Kashyap Patel, Carl MJ Kirkpatrick, Peter S Kruger, David L Paterson, Michael S Roberts, Jason A Roberts

Abstract

IntroductionThe aim of this study was to explore the impact of augmented creatinine clearance, and differing minimum inhibitory concentrations (MIC), on piperacillin pharmacokinetic/pharmacodynamic (PK/PD) target attainment (time above MIC - fT>MIC), in critically ill septic patients receiving intermittent dosing.MethodsCritically ill patients with sepsis receiving piperacillin-tazobactam 4.5 g intravenously (IV) by intermittent infusion every 6-hours for presumed or confirmed nosocomial infection, without significant renal impairment (defined by a plasma creatinine concentration >171 ¿mol/L or the need for renal replacement therapy), were eligible for enrolment. Over a single dosing interval, blood samples were drawn to determine unbound plasma piperacillin concentrations. Renal function was assessed by a measured creatinine clearance (CLCR, mL/min). A population PK model was constructed, and the probability of target attainment (PTA) for 50% and 100% fT>MIC calculated for varying MIC and CLCR values.ResultsIn total, 48 patients provided data. Increasing CLCR was associated with lower trough plasma piperacillin concentrations (P <0.01), such that with an MIC of 16 mg/L, 100% fT>MIC would only be achieved in one-third (n¿=¿16) of patients. Mean piperacillin clearance was approximately 1.5 fold higher than in healthy volunteers, and correlated with CLCR (r¿=¿0.58, P <0.01). A reduced PTA for all MIC values, when targeting either 50% or 100% fT>MIC, was noted with increasing CLCR measures.ConclusionsStandard intermittent piperacillin-tazobactam dosing is unlikely to achieve optimal piperacillin exposures in a significant proportion of critically ill patients with sepsis, due to elevated drug clearance. These data suggest CLCR can be employed as a useful tool to determine whether piperacillin PK/PD target attainment is likely with a range of MIC values.

Twitter Demographics

The data shown below were collected from the profiles of 14 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 102 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Switzerland 1 <1%
France 1 <1%
Canada 1 <1%
Japan 1 <1%
United States 1 <1%
Unknown 97 95%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 20 20%
Other 13 13%
Student > Postgraduate 12 12%
Student > Master 12 12%
Researcher 10 10%
Other 19 19%
Unknown 16 16%
Readers by discipline Count As %
Medicine and Dentistry 42 41%
Pharmacology, Toxicology and Pharmaceutical Science 24 24%
Engineering 4 4%
Agricultural and Biological Sciences 3 3%
Unspecified 2 2%
Other 6 6%
Unknown 21 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 17. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 October 2016.
All research outputs
#1,519,062
of 18,953,852 outputs
Outputs from Critical Care
#1,421
of 5,539 outputs
Outputs of similar age
#25,689
of 305,284 outputs
Outputs of similar age from Critical Care
#2
of 48 outputs
Altmetric has tracked 18,953,852 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 91st percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,539 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 17.3. This one has gotten more attention than average, scoring higher than 74% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 305,284 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 48 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 97% of its contemporaries.