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Background and Objective <p>Meropenem dosing to achieve therapeutic exposure in critically ill children with sepsis is challenging due to a spectrum of renal function, from augmented renal clearance (ARC) to acute kidney injury (AKI). The objective of this study was to define meropenem plasma concentrations and pharmacodynamic exposure metrics in children with septic shock during the first 3 days of PICU hospitalization.</p> Methods <p>We prospectively evaluated meropenem clearance (CL<sub>MERO</sub>) and volume of distribution (<i>V</i><sub>1-MERO</sub>), innovatively assessing renal biomarkers (serum creatinine [SCr], serum cystatin C [SCys], and neutrophil gelatinase-associated lipocalin [SNgal]), in infants aged ≥ 4 weeks and children on intravenous (IV) meropenem 20 mg/kg every 8 h from 2019 to 2023. Cases with sepsis were matched to controls without sepsis.</p> Results <p>Analysis included 27 participants (19 cases and 8 controls) with 309 meropenem serum concentrations. Median age was 11.8 (range 0.6–19.6) years, weight 36.3 (7.2–98.0) kg, SCr 0.33 (0.09–2.57) mg/dL, SCys 451.1 (178.3–1824.1) ng/mL, and SNgal 180.7 (23.2–1403.0) ng/mL. A 2-compartment, population pharmacokinetic (PK) model via NONMEM best described data, with weight on <i>V</i><sub>MERO</sub> and allometric scaling on CL<sub>MERO</sub>. Using the final model with SCys in <i>V</i><sub>1-MERO</sub> and estimated glomerular filtration rate (eGFR)-MS in CL<sub>MERO</sub>, the median <i>V</i><sub>1-MERO</sub> was 0.23 (range 0.07–0.57) L/kg and CL<sub>MERO</sub> 0.15 (0.05–0.49) L/h/kg, with eGFR–MS 139 (23–365) mL/min/1.73 m<sup>2</sup> from AKI to ARC. Meropenem clearance, <i>V</i><sub>1-MERO</sub> and eGFR-MS were significantly decreased in cases versus controls, with higher variability of eGFR-MS in cases.</p> Conclusion <p>Wide variation in meropenem concentrations in children with sepsis as compared to those without sepsis prompt close monitoring of GFR and drug concentrations in this population.</p>

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Variability in Meropenem Distribution and Clearance in Children with Sepsis: Population-Based Pharmacokinetics with Assessment of Renal Biomarkers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月24日

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  • Jennifer Le,
  • Julie Huynh,
  • Brandon Vo,
  • Annie Mai,
  • Robert H. Mak,
  • Jeremiah D. Momper,
  • Edmund V. Capparelli,
  • Helen Harvey,
  • Sean Avedissian,
  • Erin Bradley,
  • Amy Sitapati,
  • Karandeep Singh,
  • John S. Bradley

摘要

Background and Objective

Meropenem dosing to achieve therapeutic exposure in critically ill children with sepsis is challenging due to a spectrum of renal function, from augmented renal clearance (ARC) to acute kidney injury (AKI). The objective of this study was to define meropenem plasma concentrations and pharmacodynamic exposure metrics in children with septic shock during the first 3 days of PICU hospitalization.

Methods

We prospectively evaluated meropenem clearance (CLMERO) and volume of distribution (V1-MERO), innovatively assessing renal biomarkers (serum creatinine [SCr], serum cystatin C [SCys], and neutrophil gelatinase-associated lipocalin [SNgal]), in infants aged ≥ 4 weeks and children on intravenous (IV) meropenem 20 mg/kg every 8 h from 2019 to 2023. Cases with sepsis were matched to controls without sepsis.

Results

Analysis included 27 participants (19 cases and 8 controls) with 309 meropenem serum concentrations. Median age was 11.8 (range 0.6–19.6) years, weight 36.3 (7.2–98.0) kg, SCr 0.33 (0.09–2.57) mg/dL, SCys 451.1 (178.3–1824.1) ng/mL, and SNgal 180.7 (23.2–1403.0) ng/mL. A 2-compartment, population pharmacokinetic (PK) model via NONMEM best described data, with weight on VMERO and allometric scaling on CLMERO. Using the final model with SCys in V1-MERO and estimated glomerular filtration rate (eGFR)-MS in CLMERO, the median V1-MERO was 0.23 (range 0.07–0.57) L/kg and CLMERO 0.15 (0.05–0.49) L/h/kg, with eGFR–MS 139 (23–365) mL/min/1.73 m2 from AKI to ARC. Meropenem clearance, V1-MERO and eGFR-MS were significantly decreased in cases versus controls, with higher variability of eGFR-MS in cases.

Conclusion

Wide variation in meropenem concentrations in children with sepsis as compared to those without sepsis prompt close monitoring of GFR and drug concentrations in this population.