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Review
. 2024 Aug 24;13(9):801.
doi: 10.3390/antibiotics13090801.

Risk Factors Associated with Antibiotic Exposure Variability in Critically Ill Patients: A Systematic Review

Laura Gras-Martín  1   2   3 , Adrián Plaza-Diaz  1   2 , Borja Zarate-Tamames  1   2 , Paula Vera-Artazcoz  2   3   4 , Olga H Torres  2   3   5 , Carla Bastida  6   7 , Dolors Soy  6   7 , Jesús Ruiz-Ramos  1   2   3
Affiliations
Review

Risk Factors Associated with Antibiotic Exposure Variability in Critically Ill Patients: A Systematic Review

Laura Gras-Martín et al. Antibiotics (Basel). .

Abstract

(1) Background: Knowledge about the behavior of antibiotics in critically ill patients has been increasing in recent years. Some studies have concluded that a high percentage may be outside the therapeutic range. The most likely cause of this is the pharmacokinetic variability of critically ill patients, but it is not clear which factors have the greatest impact. The aim of this systematic review is to identify risk factors among critically ill patients that may exhibit significant pharmacokinetic alterations, compromising treatment efficacy and safety. (2) Methods: The search included the PubMed, Web of Science, and Embase databases. (3) Results: We identified 246 observational studies and ten clinical trials. The most studied risk factors in the literature were renal function, weight, age, sex, and renal replacement therapy. Risk factors with the greatest impact included renal function, weight, renal replacement therapy, age, protein or albumin levels, and APACHE or SAPS scores. (4) Conclusions: The review allows us to identify which critically ill patients are at a higher risk of not reaching therapeutic targets and helps us to recognize the extensive number of risk factors that have been studied, guiding their inclusion in future studies. It is essential to continue researching, especially in real clinical practice and with clinical outcomes.

Keywords: antibiotic; critically ill patients; exposure; pharmacodynamics; pharmacokinetics; risk factors; target attainment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Search results. PRISMA Flow Diagram.
Figure 2
Figure 2
Number of studies with the ten most relevant risk factors. (a) For risk factors. (b) For antibiotics.
Figure 3
Figure 3
Details of variables included renal function, hepatic function, weight, and renal replacement therapy as risk factors. AKI: Acute kidney injury, ARC: Augmented renal clearance, BMI: body mass index, BSA: body surface area, CRRT: continuous renal replacement therapy, SLED: sustained low-efficiency dialysis.
Figure 4
Figure 4
Risk factors with different relevance versus those analyzed, represented on two different scales. The size of the ball indicates the number of patients analyzed. ECMO: Extracorporeal Membrane Oxygenation; Hb: Hemoglobin; Ht Hematocrit.
See this image and copyright information in PMC

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