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Online ISSN 1827-1596
Cremaschi E. 1, Maggiore U. 1, Maccari C. 1, Cademartiri C. 1, Andreoli R. 2, Fiaccadori E. 1
1 Department of Medical Clinic, Nephrology and Prevention, University of Parma, Parma, Italy;
2 Laboratory of Industrial Tossicology, University of Parma, Parma, Italy
We report on a patient with biliary sepsis due to Vancomycin-resistant Enterococcus faecium (VRE) treated with linezolid (LNZ), who had both hepatic failure and acute kidney injury requiring daily sustained low-efficiency dialysis (SLED), a new intermittent, prolonged diffusive modality of renal replacement therapy for ICU patients. Following cholecistostomy and peritoneal drain insertion, serum, bile and peritoneal fluid serial samples were simultaneously collected for LNZ concentration measurement (chromatography/mass spectrometry). Unusually high serum antibiotic levels (20 mg/L or more) were achieved as early as 36 hours since the start of LNZ administration, owing to relatively low hepatic clearance. Serum LNZ leveled off after commencing SLED, apparently reaching steady state levels. The lowest values of Cmin in bile was 5.86 mg/L; the average serum and bile AUC0-12 over the observation period were 204 mg/L*h and 276 mg/L*h, with a AUC0-24/MIC ratio of 227 h and 307 h, respectively. The excellent biliary pharmacodynamic exposure suggests that standard-dose LNZ might represent a valuable choice in severe biliary infection, even in the presence of hepatic failure, when the patients receive highly efficient modalities of renal replacement therapy.