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Kidney Week

Abstract: FR-PO227

Evaluation of Optimal Cefazolin Regimen in Hemodialysis Patients

Session Information

  • Pharmacology
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

  • 1900 Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

Authors

  • Pichette, Maude, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Elftouh, Naoual, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Tessier, Jean-François, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

Cefazolin is commonly used among patients on hemodialysis (HD) to treat gram-positive infections although equipoise persists on the optimal regimen in this specific population.

Methods

The primary aim of this observational prospective study was to compare free cefazolin plasmatic concentrations between 3 regimens (2-2-3g post-HD / 1g daily / 2g daily) in adult patients from a single center receiving cefazolin between Sept 2020 and Jan 2022. Our secondary aim was to determine if cefazolin levels were above the local minimum inhibitory concentration (MIC) with each regimen. The antibiotic regimen was determined by the patient’s treating team (nephrologists and/or microbiologists) independent from the study. Local MIC’s for methicillin-sensitive staphylococcus aureus (MSSA) were measured for patients in whom it was available, with 4 times the MIC considered as a therapeutic target according to the literature.

Results

72 cefazolin dosages were obtained from 25 patients, with 15 patients receiving 2-2-3g post-HD, 6 patients treated with 1g daily and 4 patients with 2g daily. The most frequent indications for cefazolin were catheter infections (n=6), cutaneous infections (n=6) and osteitis (n=5). Of note, two patients had endocarditis and 10 patients (40%) had a MSSA bacteremia. Among patients with bacteremia, two patients were treated with 2-2-3g post-HD regimen, 4 received 1g daily and 4 patients had 2g daily. The mean free plasma concentrations of cefazolin were 23.3±13.6 mg/L, 33.2±12.7 mg/L and 67.5±21.6 mg/L for the 2-2-3g post-HD / 1g daily / 2g daily respectively. The local MICs ranged from 0.25 to 1 mg/L.

Conclusion

In all the three regimens, the free plasmatic levels of cefazolin were above the local MIC’s. Our data show that a thrice-weekly post-HD regimen should be prioritized in MSSA infection in hemodialysis, especially in outpatient settings, to avoid the need of peripheral access and reduce the time and human resources associated to daily antibiotics.