Beta-lactam underdosing is not more frequent in COVID-19 than in non-COVID-19 critically ill patients.

OBJECTIVES

COVID-19 has been associated with high rates of ventilator-associated pneumonia relapse. Antibiotic underdosing due to augmented renal clearance (ARC) has been suggested as a possible contributing factor. This retrospective study compared plasmatic beta-lactam concentrations between critically-ill COVID-19 and non-COVID-19 patients.

PATIENTS AND

METHODS

We included measurements for cefotaxime, ceftazidime, cefepime and piperacillin. A multivariable logistic regression model was used to identify variables associated with underdosing.

RESULTS

All in all, 361 samples were included from 126 patients. Median concentrations did not differ between COVID-19 and non-COVID-19 patients for any molecule, nor did the rate of underdosing (38 % vs 42 %, p = 0.68). In a logistic regression model adjusting for age, gender, BMI, creatinine clearance and type of beta-lactam molecule, COVID-19 status was not associated with underdosing (OR = 0.83 [0.38-1.83], p = 0.997).

CONCLUSIONS

Although underdosing of most commonly prescribed beta-lactams occurred in more than one third of cases in critically-ill COVID-19 patients, this rate did not differ from non-COVID-19 patients.