For these reasons, our team is working to optimize antibiotic treatment through via multiple aims: 1. understand how to ensure adequate antibiotic concentrations in critically ill children; 2. recognize and avoid beta-lactam associated toxicities; and 3. determine when antibiotic dosing should be adjusted from the standard weight-based strategy. Projects underway include developing models to predict ceftriaxone and piperacillin-tazobactam levels in critically ill children; assessing how fluids given during early severe sepsis therapy affect meropenem concentrations; and defining cefepime-associated neurotoxicity and understanding which patients are most at risk.
Our team includes Kelli Paice, MD and Katie Pavia, MD, two 3rd year critical care and clinical pharmacology fellows (both have been awarded National Institutes of Health T32 fellowships in Pediatric Clinical Pharmacology and will be staying at CCHMC for an additional year devoted to research); Sonya Tang Girdwood, MD, PhD from the Divisions of Hospital Medicine and Clinical Pharmacology; and Jennifer Kaplan, MD, MS who is the Director of Clinical Research for the Division of Critical Care Medicine.
In the coming year we will be conducting multiple additional research studies in the PICU with the help of our clinical research coordinators, clinical research nurses, and colleagues from the Division of Clinical Pharmacology. Much of our work makes use of “opportunistic sampling”, where we obtain blood left over from labs collected for use in clinical care and measure the antibiotic concentrations in the remaining sample. This technique helps overcome one of the classic challenges of research in pediatric patients – avoiding a high burden of “pokes” and blood loss in our smallest patients. We aim to be one of the first children’s hospitals in the United States to provide in-house β-lactam antibiotic assays and an antibiotic precision dosing service to provide clinicians information on precision dosing of antibiotics. Overall, our team’s goal is to move closer to the ideal of “precision medicine” – where every child can be treated with medicines and procedures that are tailored to their unique physiology, genetics, and clinical situation.