Measuring antibiotics in exhaled air in critically ill, non-ventilated patients: A feasibility and proof of concept study

J Crit Care. 2019 Jun;51:46-50. doi: 10.1016/j.jcrc.2019.01.025. Epub 2019 Jan 28.

Abstract

Purpose: Measurement of antibiotic concentrations is increasingly used to optimize antibiotic therapy. Plasma samples are typically used for this, but other matrices such as exhaled air could be an alternative.

Materials and methods: We studied 11 spontaneously breathing intensive care unit patients receiving either piperacillin/tazobactam or meropenem. Patients exhaled in the ExaBreath® device, from which the antibiotic was extracted. The presence of antibiotics was also determined in the condensate found in the device and in the plasma.

Results: Piperacillin or meropenem could be detected in the filter in 9 patients and in the condensate in 10. Seven patients completed the procedure as prescribed. In these patients the median quantity of piperacillin in the filter was 3083 pg/filter (range 988-203,895 pg/filter), and 45 pg (range 6-126 pg) in the condensate; meropenem quantity was 21,168 pg/filter, but the quantity in the condensate was below the lower limit of quantification. There was no correlation between the concentrations in the plasma and quantities detected in the filter or condensate.

Conclusions: Piperacillin and meropenem can be detected and quantified in exhaled air of non-ventilated intensive care unit patients; these quantities did not correlate with plasma concentrations of these drugs.

Keywords: Beta-lactam antibiotics; Exhaled breath; SensAbues; Therapeutic drug monitoring; UHPLC-HR-MS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacokinetics*
  • Anti-Bacterial Agents / therapeutic use
  • Breath Tests*
  • Chromatography, Liquid
  • Critical Illness / therapy*
  • Exhalation
  • Feasibility Studies
  • Humans
  • Meropenem / pharmacokinetics*
  • Meropenem / therapeutic use
  • Piperacillin, Tazobactam Drug Combination / pharmacokinetics*
  • Piperacillin, Tazobactam Drug Combination / therapeutic use
  • Proof of Concept Study

Substances

  • Anti-Bacterial Agents
  • Piperacillin, Tazobactam Drug Combination
  • Meropenem