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Clin Chim Acta. 2018 Nov;486:265-268. doi: 10.1016/j.cca.2018.08.008. Epub 2018 Aug 15.

Beta-lactam carryover in arterial and central venous catheters is negligible.

Author information

1
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, United States of America.
2
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, United States of America. Electronic address: william.fissell@vumc.org.
3
Division of Pharmaceutics and Translational Therapeutics College of Pharmacy, University of Iowa, Iowa, United States of America.
4
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, United States of America.
5
Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America.
6
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America.

Abstract

BACKGROUND:

Therapeutic drug monitoring is used for aminoglycosides and vancomycin, and has been proposed for β-lactam antibiotics. Clinical blood samples in the ICU are often obtained via an existing vascular catheter rather than fresh needle phlebotomy. If antibiotics had previously been infused through a vascular catheter then used for blood sampling, carryover of antibiotic from the infusion to the sample might result in misleading assessments of target attainment. To address this concern we conducted a series of in vitro measurements of carryover for three commonly used antibiotics.

METHODS:

We infused piperacillin-tazobactam, meropenem, and cefepime at pharmacologic concentrations through commonly used vascular catheters at our hospital and flushed the catheters. We then aspirated warmed citrated bovine blood through each catheter and measured antibiotic concentrations in each aspirate.

RESULTS:

Carryover was below the limits of detection for piperacillin-tazobactam, meropenem, and vancomycin. Cefepime carryover, in contrast, was not negligible and needs to be investigated more fully.

CONCLUSION:

Carryover from prior infusions does not appear to jeopardize measurements of piperacillin-tazobactam, meropenem, or vancomycin in commonly used vascular catheters at our institution. Caution in interpreting samples obtained for cefepime measurements appears advised until more data is available.

KEYWORDS:

Beta-lactam; Phlebotomy; Therapeutic drug monitoring

PMID:
30118674
DOI:
10.1016/j.cca.2018.08.008
[Indexed for MEDLINE]

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