Voriconazole Pharmacokinetics in Critically Ill Patients and Extracorporeal Membrane Oxygenation Support: A Retrospective Comparative Case-Control Study
Mar Ronda,
Josep Manuel Llop-Talaveron,
MariPaz Fuset,
Elisabet Leiva,
Evelyn Shaw,
Victor Daniel Gumucio-Sanguino,
Yolanda Diez,
Helena Colom,
Raul Rigo-Bonnin,
Mireia Puig-Asensio,
Jordi Carratalà,
Ariadna Padullés
Affiliations
Mar Ronda
Infectious Disease Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Josep Manuel Llop-Talaveron
Pharmacy Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
MariPaz Fuset
Critical Care Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Elisabet Leiva
Pharmacy Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Evelyn Shaw
Infectious Disease Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Victor Daniel Gumucio-Sanguino
Critical Care Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Yolanda Diez
Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Helena Colom
Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy, University of Barcelona, 08028 Barcelona, Spain
Raul Rigo-Bonnin
Clinical Laboratory, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Mireia Puig-Asensio
Infectious Disease Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Jordi Carratalà
Infectious Disease Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Ariadna Padullés
Pharmacy Department, Hospital Universitari de Bellvitge–IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain
Voriconazole, an antifungal agent, displays high intra- and inter-individual variability. The predictive pharmacokinetic (PK) index requires a minimum plasma concentration (Cmin) in patient serum of between 1–5.5 mg/L. It is common to encounter fungal infections in patients undergoing extracorporeal membrane oxygenation (ECMO) support, and data regarding voriconazole PK changes during ECMO are scarce. Our study compared voriconazole PKs in patients with and without ECMO support in a retrospective cohort of critically-ill patients. Fifteen patients with 26 voriconazole Cmin determinations in the non-ECMO group and nine patients with 27 voriconazole Cmin determinations in the ECMO group were recruited. The ECMO group had lower Cmin (0.38 ± 2.98 vs. 3.62 ± 3.88, p min values (16 vs. 1, p 95 −0.978–−0.358) and plasma albumin levels (−0.023, CI95 −0.046–−0.001) as risk factors for low Cmin values. When comparing pre- and post-therapeutic drug optimisation samples from the ECMO group, the dose required to achieve therapeutic Cmin was 6.44 mg/kg twice a day. Therapeutic drug optimisation is essential to improve target attainment.
