The Journal of antimicrobial chemotherapy · 2026
Incidence and factors associated with subtherapeutic cefazolin levels among patients with severe infections.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Shah Sunish, Marini Rachel V, Shields Ryan K, Smith Brandon J
Аннотация
OBJECTIVES: We report on our initial clinical experience and identify factors associated with subtherapeutic cefazolin levels among patients with severe infections.
METHODS: This was an observational study of patients treated with cefazolin guided by therapeutic drug monitoring (TDM) for severe infections. Cefazolin trough levels were collected and considered subtherapeutic when total drug concentrations were <40 mg/L. Hypoalbuminemia was defined as an albumin level of <3 g/dL within 72 h of cefazolin TDM. Trough levels were drawn within 90 min of the next scheduled dose for intermittent regimens. Steady state levels were drawn after at least 8 h of cefazolin via continuous infusion.
RESULTS: Seventy patients were included. Overall, 76% (53/70) of patients had bloodstream infections, of whom 60% (32/53) had definitive endocarditis. MSSA was the underlying pathogen in 86% (60/70) of cases. Subtherapeutic levels were observed in 39% (27/70) of patients. The total median (IQR) daily cefazolin dose was similar among patients who received dosing by continuous and intermittent infusions [6 g (6-8) versus 6 g (6-6), P = 0.271]; however, those who received continuous infusions had a higher median (IQR) cefazolin level [61 mcg/mL) (38-80) versus 38 (19-71), P = 0.012]. Among those with measured albumin levels (n = 55), hypoalbuminemia was associated with endocarditis [OR = 11.9; 95% CI: 2.4-59.1; P = 0.002] and a lower cefazolin concentration [OR = 0.97; 95%CI: 0.95-0.99; P = 0.026].
CONCLUSIONS: Despite standard dosing with cefazolin, subtherapeutic levels were commonly observed. Factors associated with subtherapeutic levels included hypoalbuminemia and administration by intermittent infusion. Future studies are imperative to validate or refute current therapeutic targets for cefazolin.
METHODS: This was an observational study of patients treated with cefazolin guided by therapeutic drug monitoring (TDM) for severe infections. Cefazolin trough levels were collected and considered subtherapeutic when total drug concentrations were <40 mg/L. Hypoalbuminemia was defined as an albumin level of <3 g/dL within 72 h of cefazolin TDM. Trough levels were drawn within 90 min of the next scheduled dose for intermittent regimens. Steady state levels were drawn after at least 8 h of cefazolin via continuous infusion.
RESULTS: Seventy patients were included. Overall, 76% (53/70) of patients had bloodstream infections, of whom 60% (32/53) had definitive endocarditis. MSSA was the underlying pathogen in 86% (60/70) of cases. Subtherapeutic levels were observed in 39% (27/70) of patients. The total median (IQR) daily cefazolin dose was similar among patients who received dosing by continuous and intermittent infusions [6 g (6-8) versus 6 g (6-6), P = 0.271]; however, those who received continuous infusions had a higher median (IQR) cefazolin level [61 mcg/mL) (38-80) versus 38 (19-71), P = 0.012]. Among those with measured albumin levels (n = 55), hypoalbuminemia was associated with endocarditis [OR = 11.9; 95% CI: 2.4-59.1; P = 0.002] and a lower cefazolin concentration [OR = 0.97; 95%CI: 0.95-0.99; P = 0.026].
CONCLUSIONS: Despite standard dosing with cefazolin, subtherapeutic levels were commonly observed. Factors associated with subtherapeutic levels included hypoalbuminemia and administration by intermittent infusion. Future studies are imperative to validate or refute current therapeutic targets for cefazolin.