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已发表论文
重度肾功能损伤危重患者在静脉-动脉体外膜氧合期间头孢他啶-阿维巴坦的药代动力学变化：一例病例报告
Authors Shen Z, Qin H, Li Q, Mao X
Received 17 October 2025
Accepted for publication 2 February 2026
Published 13 February 2026 Volume 2026:19 574866
DOI https://doi.org/10.2147/IDR.S574866
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Sandip Patil
Zhuowei Shen,1 Hui Qin,1 Qian Li,2 Xiaohong Mao1
1Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
Correspondence: Xiaohong Mao, Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Email maoxhzhz@163.com Qian Li, Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Email liqian5826@126.com
Abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an advanced life support therapy, but evidence regarding its impact on the pharmacokinetic (PK) characteristics of ceftazidime–avibactam (CAZ-AVI) is still limited. This study reports a 47-year-old man who developed severe renal impairment during VA-ECMO support following cardiac arrest and was treated with CAZ-AVI for pneumonia caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Therapeutic drug monitoring (TDM) was performed before and after VA-ECMO weaning. PK analysis showed that, compared to the period with VA-ECMO support, the clearances (CLs) of CAZ and AVI increased after VA-ECMO weaning, resulting in 31.1% and 34.5% decreases in systemic exposure to CAZ and AVI, respectively. Despite these reductions, trough concentrations remained above the PK/PD targets of 100% fT > 20.0 mg/L for CAZ and 100% fT > 4.0 mg/L for AVI, respectively. Unfortunately, the patient’s renal function progressively worsened, complicated by hyperkalemia, and he experienced a second cardiac arrest on day 5 after ECMO weaning, resulting in death. These findings suggest that in patients undergoing prolonged VA-ECMO support, the exposure of CAZ-AVI may decline after ECMO weaning, underscoring the need for reassessment of dosing strategies.
Keywords: Ceftazidime, Avibactam, Pharmacokinetics, VA-ECMO
1Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
Correspondence: Xiaohong Mao, Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Email maoxhzhz@163.com Qian Li, Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Email liqian5826@126.com
Abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an advanced life support therapy, but evidence regarding its impact on the pharmacokinetic (PK) characteristics of ceftazidime–avibactam (CAZ-AVI) is still limited. This study reports a 47-year-old man who developed severe renal impairment during VA-ECMO support following cardiac arrest and was treated with CAZ-AVI for pneumonia caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Therapeutic drug monitoring (TDM) was performed before and after VA-ECMO weaning. PK analysis showed that, compared to the period with VA-ECMO support, the clearances (CLs) of CAZ and AVI increased after VA-ECMO weaning, resulting in 31.1% and 34.5% decreases in systemic exposure to CAZ and AVI, respectively. Despite these reductions, trough concentrations remained above the PK/PD targets of 100% fT > 20.0 mg/L for CAZ and 100% fT > 4.0 mg/L for AVI, respectively. Unfortunately, the patient’s renal function progressively worsened, complicated by hyperkalemia, and he experienced a second cardiac arrest on day 5 after ECMO weaning, resulting in death. These findings suggest that in patients undergoing prolonged VA-ECMO support, the exposure of CAZ-AVI may decline after ECMO weaning, underscoring the need for reassessment of dosing strategies.
Keywords: Ceftazidime, Avibactam, Pharmacokinetics, VA-ECMO