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Bacterial infections are a major problem in intensive care patients
One third of patients with an infection in intensive care die. Antibiotics are therefore crucial, but is the application optimal in this group of patients? Eveline Wallenburg of Radboudumc shows in her thesis that intensive care patients often receive the wrong dose of antibiotics. She developed computer models that determine the correct dosage.
Bacterial infections are a major problem in intensive care patients. As many as 30% of these patients die. That is why antibiotics are of enormous importance in the intensive care unit. However, patients must of course receive the correct dosage. Too low a dose does not fight the infection sufficiently, while too high a dose can have dangerous side effects. The problem is that the standard doses are based on studies in healthy volunteers, or patients not admitted to intensive care. PhD candidate Eveline Wallenburg: ‘Intensive care patients cannot be compared with that. For example, the kidneys of these patients often work less well or too quickly.’ The kidneys play a major role in removing drugs from the body through the urine. Therefore, a change in kidney function greatly affects the blood levels of drugs, including various antibiotics. Therefore, intensive care patients may need adjusted dosages to ensure safety and effectiveness.
Standard dose too low
The research in Wallenburg’s thesis is aimed at improving the dosing of three commonly used antibiotics in the intensive care unit. To do this, she measured blood levels of these antibiotics in patients during their admission to the intensive care unit. She also collected other information, such as age, gender and kidney function. Wallenburg combined all this data into computer models. This showed that the standard dose of two of the antibiotics studied was often too low, especially in patients with overactive kidneys. ‘For example, we saw that with the standard dose, only a few percent of patients had sufficiently high blood levels of an antibiotic,’ says Wallenburg. ‘These patients should therefore receive a much higher dose. The model also provides advice on the correct dosage based on a number of patient data.’
Dosage software
The models are now processed in software that is suitable for use in daily practice. Will measuring blood levels no longer be necessary in the future? Wallenburg: ‘Measuring is also important, especially in patients who, for example, have very poor or very fast kidney function. Blood levels are also difficult to predict in patients on kidney dialysis, so we have to measure them. However, our models are already sufficiently accurate for use in practice if the kidney function is not too abnormal.’
To combine forces
‘Eveline has laid a very important foundation for future research into the optimal dosage of antibiotics’, says Roger Brüggemann, co-supervisor and leader of the study. He talks about the next steps: ‘Firstly, we will determine whether the blood levels of antibiotics that are considered effective are real. These levels were once determined in laboratory animals, laboratory research or very small groups of patients. The question is whether these are accurate enough.’ To do this, Brüggemann and his colleagues collect data from large groups of patients from several hospitals in the Netherlands and abroad. ‘Secondly, we are looking at the application of antibiotics at the site of infection.’ Infections are sometimes present in only one organ, for example in the brain, lungs or joints. However, administration of antibiotics into the bloodstream exposes the whole body to these agents. That causes many side effects. Brüggemann: ‘That is why we are investigating whether we can administer antibiotics locally for certain infections.’ Finally, he is committed to further collaboration between various disciplines within the hospital: ‘Eveline’s research was a very fruitful collaboration between the pharmacy and the intensive care unit. We also involve microbiologists, infectiologists and immunologists in the research. They know everything about the sensitivity of bacteria to antibiotics and the immune system of the patient. There is so much knowledge available and if we join forces we will improve the care for patients with infections even further.’
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https://www.radboudumc.nl/nieuws/2022/computer-bepaalt-de-juiste-dosering-antibiotica-voor-patienten-op-de-ic - Original title:
Computer determines the correct dose of antibiotics for patients in the ICU - Target audience:
Healthcare professionals - Datum:
2022-08-29