{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:22:26Z","timestamp":1787235746254,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Key Research and Development Projects of Shaanxi","award":["2019ZDLSF01\u201305"],"award-info":[{"award-number":["2019ZDLSF01\u201305"]}]},{"name":"Key Research and Development Program of Shaanxi","award":["2020SF-064"],"award-info":[{"award-number":["2020SF-064"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>The dosage regimen of vancomycin, teicoplanin and daptomycin remains controversial for critically ill patients undergoing continuous renal replacement therapy (CRRT). Monte Carlo simulation was applied to identify the optimal regimens of antimicrobial agents in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections based on the mechanisms of different CRRT modalities on drug clearance. The optimal vancomycin dosage for patients received a CRRT doses \u2264 30 mL\/kg\/h was 20 mg\/kg loading dose followed by 500 mg every 8 h, while 1 g every 12 h was appropriate when 35 mL\/kg\/h was prescribed. The optimal teicoplanin dosage under a CRRT dose \u2264 25 mL\/kg\/h was four loading doses of 10 mg\/kg every 12 h followed by 10 mg\/kg every 48 h, 8 mg\/kg every 24 h and 6 mg\/kg every 24 h for continuous veno-venous hemofiltration, continuous veno-venous hemodialysis and continuous veno-venous hemodiafiltration, respectively. When the CRRT dose increased to 30\u201335 mL\/kg\/h, the teicoplanin dosage should be increased by 30%. The recommended regimen for daptomycin was 6\u20138 mg\/kg every 24 h under a CRRT dose \u2264 25 mL\/kg\/h, while 8\u201310 mg\/kg every 24 h was optimal under 30\u201335 mg\/kg\/h. The CRRT dose has an impact on probability of target attainment and CRRT modality only influences teicoplanin.<\/jats:p>","DOI":"10.3390\/pharmaceutics14040842","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T02:48:59Z","timestamp":1649731739000},"page":"842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Optimizing Antimicrobial Dosing for Critically Ill Patients with MRSA Infections: A New Paradigm for Improving Efficacy during Continuous Renal Replacement Therapy"],"prefix":"10.3390","volume":"14","author":[{"given":"Jiaojiao","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quanfang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7328-9851","authenticated-orcid":false,"given":"Chuhui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulan","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luting","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiying","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6459-7139","authenticated-orcid":false,"given":"Taotao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.2020.2717","article-title":"Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017","volume":"323","author":"Vincent","year":"2020","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S344","DOI":"10.1086\/533590","article-title":"Epidemiology of methicillin-resistant Staphylococcus aureus","volume":"46","author":"Boucher","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1093\/jac\/dkm365","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries","volume":"60","author":"Borg","year":"2007","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.ijantimicag.2011.05.013","article-title":"Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: Results from the EPIC II study","volume":"38","author":"Hanberger","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1093\/cid\/ciq146","article-title":"Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children","volume":"52","author":"Liu","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/jac\/dkl017","article-title":"Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK","volume":"57","author":"Gemmell","year":"2006","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1111\/bcp.13904","article-title":"Predicting the dose of vancomycin in ICU patients receiving different types of RRT therapy: A model-based meta-analytic approach","volume":"85","author":"Claisse","year":"2019","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.chest.2018.09.004","article-title":"Continuous Renal Replacement Therapy: Who, When, Why, and How","volume":"155","author":"Tandukar","year":"2019","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00134-015-3934-7","article-title":"Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study","volume":"41","author":"Hoste","year":"2015","journal-title":"Intensiv. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/BF01700172","article-title":"Pharmacokinetics of continuous renal replacement therapy","volume":"21","author":"Schetz","year":"1995","journal-title":"Intensiv. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.ijantimicag.2011.04.010","article-title":"Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients","volume":"38","author":"Chaijamorn","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000353400","article-title":"Pharmacokinetics of daily daptomycin in critically ill patients undergoing continuous renal replacement therapy","volume":"59","author":"Corti","year":"2013","journal-title":"Chemotherapy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5804","DOI":"10.1128\/AAC.01758-10","article-title":"Proposal of a phar-macokinetically optimized dosage regimen of antibiotics in patients receiving continuous hemodiafiltration","volume":"55","author":"Yamamoto","year":"2011","journal-title":"Antimicrob. Agents. Chemother."},{"key":"ref_14","first-page":"243","article-title":"Teicoplanin pharmacokinetics in critically ill patients on continuous veno-venous hemofiltration","volume":"48","author":"Bellmann","year":"2010","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1086\/444500","article-title":"Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy","volume":"41","author":"Trotman","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1365-2125.2004.02143.x","article-title":"Vancomycin pharmacokinetics in critically ill patients receiving continuous venovenous hae-modiafiltration","volume":"58","author":"DelDot","year":"2004","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.eimc.2011.09.013","article-title":"Antibiotic dose adjustment in the treatment of MRSA infections in patients with acute renal failure undergoing continuous renal replacement therapies","volume":"30","author":"Carcelero","year":"2012","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ijantimicag.2012.10.018","article-title":"Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy","volume":"41","author":"Covajes","year":"2013","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jcrc.2019.07.008","article-title":"Optimal vancomycin dosing regimens for critically ill patients with acute kidney injury during continuous renal replacement therapy: A Monte Carlo simulation study","volume":"54","author":"Charoensareerat","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/hdi.12704","article-title":"High variability of teicoplanin concentration in patients with continuous venovenous hemodiafiltration","volume":"23","author":"Lim","year":"2019","journal-title":"Hemodial. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/bcp.13131","article-title":"Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy","volume":"83","author":"Xu","year":"2016","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/jac\/dkq449","article-title":"Monte Carlo simulations: Maximizing antibiotic pharmacokinetic data to optimize clinical practice for critically ill patients","volume":"66","author":"Roberts","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"292","DOI":"10.2165\/00003088-198712040-00003","article-title":"Teicoplanin phar-macokinetics in patients with chronic renal failure","volume":"12","author":"Bonati","year":"1987","journal-title":"Clin. Pharmacokinet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1093\/jac\/dkaa028","article-title":"Population pharmacokinetics and dosing considerations of daptomycin in critically ill patients undergoing continuous renal replacement therapy","volume":"75","author":"Xie","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1159\/000097078","article-title":"Daptomycin Clearance during Modeled Continuous Renal Replacement Therapy","volume":"24","author":"Churchwell","year":"2006","journal-title":"Blood Purif."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/CCM.0b013e3181fa36fb","article-title":"Daptomycin pharmacoki-netics in critically ill patients receiving continuous venovenous hemodialysis","volume":"39","author":"Vilay","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1038\/clpt.1991.208","article-title":"Vancomycin pharmacokinetics in acute renal failure: Preservation of nonrenal clearance","volume":"50","author":"Macias","year":"1991","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"VA\/NIH Acute Renal Failure Trial Network, Palevsky, P.M., Zhang, J.H., O\u2019Connor, T.Z., Chertow, G.M., Crowley, S.T., Choudhury, D., Finkel, K.W., Kellum, J.A., and Paganini, E.P. (2008). Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury. N. Engl. J. Med., 359, 7\u201320.","DOI":"10.1056\/NEJMoa0802639"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1097\/CCM.0b013e3181aab3d0","article-title":"Principles of antibacterial dosing in continuous renal replacement therapy","volume":"37","author":"Choi","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1159\/000328740","article-title":"Effects of High Blood Flow and High Pre-Dilution Replacement Fluid Rates on Small Solute Clearances in Hemofiltration","volume":"32","author":"Gashti","year":"2011","journal-title":"Blood Purif."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s00134-020-06050-1","article-title":"Antimicrobial therapeutic drug monitoring in critically ill adult patients: A Position Paper","volume":"46","author":"Alffenaar","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/j.1469-0691.2007.01885.x","article-title":"Pharmacodynamic comparison of linezolid, teicoplanin and vancomycin against clinical isolates of Staphylococcus aureus and coagulase-negative staphylococci collected from hospitals in Brazil","volume":"14","author":"Kuti","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijantimicag.2018.09.015","article-title":"Current use of daptomycin and systematic therapeutic drug monitoring: Clinical experience in a tertiary care institution","volume":"53","author":"Galar","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4942","DOI":"10.1128\/AAC.49.12.4942-4949.2005","article-title":"Structure-Guided Discovery of Novel Aminoglycoside Mimetics as Antibacterial Translation Inhibitors","volume":"49","author":"Zhou","year":"2005","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/jac\/dki079","article-title":"Standardization of pharmacokinetic\/pharmacodynamic (PK\/PD) terminology for anti-infective drugs: An update","volume":"55","author":"Mouton","year":"2005","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/jac\/dkq348","article-title":"Pharmacodynamics of empirical antibiotic monotherapies for an intensive care unit (ICU) population based on Canadian surveillance data","volume":"66","author":"Zelenitsky","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40262-012-0018-5","article-title":"The Clinical Relevance of Plasma Protein Binding Changes","volume":"52","author":"Roberts","year":"2013","journal-title":"Clin. Pharmacokinet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s13054-018-2155-1","article-title":"Pharmacokinetics\u2013pharmacodynamics issues relevant for the clinical use of beta-lactam antibiotics in critically ill patients","volume":"22","author":"Veiga","year":"2018","journal-title":"Crit. Care"},{"key":"ref_39","first-page":"196","article-title":"Initial vancomycin dosing recommen-dations for critically ill patients undergoing continuous venovenous hemodialysis","volume":"63","author":"Walker","year":"2010","journal-title":"Can. J. Hosp. Pharm."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10156-013-0599-4","article-title":"Practice guidelines for therapeutic drug monitoring of vancomycin: A consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring","volume":"19","author":"Matsumoto","year":"2013","journal-title":"J. Infect. Chemother."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/BF00199886","article-title":"Pharmacokinetics and dosage recommendations of teicoplanin in patients treated by continuous veno-venous haemodialysis (CVVHD)","volume":"46","author":"Wolter","year":"1994","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"786","DOI":"10.3389\/fphar.2020.00786","article-title":"Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy","volume":"11","author":"Li","year":"2020","journal-title":"Front. Pharmacol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/sdi.12203","article-title":"Antibiotic dosing in critically ill patients receiving CRRT: Under dosing is over prevalent","volume":"27","author":"Lewis","year":"2014","journal-title":"Semin. Dial."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Wang, C., Zhang, C., Li, X., Zhao, S., He, N., Zhai, S., and Ge, Q. (2021). Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK\/PD Analysis. Antibiotics, 10.","DOI":"10.3390\/antibiotics10111392"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00228-019-02755-5","article-title":"Pharmacokinetics of and maintenance dose recommendations for vancomycin in severe pneumonia patients undergoing continuous venovenous hemofiltration with the combination of predilution and postdilution","volume":"76","author":"Li","year":"2020","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1007\/s00134-003-1914-9","article-title":"Pharmacokinetics of teicoplanin in critically ill patients undergoing continuous hemodiafiltration","volume":"29","author":"Yagasaki","year":"2003","journal-title":"Intensive Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1093\/jac\/dkr551","article-title":"Multiple-dose pharmacokinetics of daptomycin during continuous venovenous haemodiafiltration","volume":"67","author":"Wenisch","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"656","DOI":"10.5414\/CP201626","article-title":"Plasma pharmacokinetics of daptomycin in critically ill patients with renal failure and undergoing CVVHD","volume":"49","author":"Khadzhynov","year":"2011","journal-title":"Int. J. Clin. Pharmacol. Ther."}],"container-title":["Pharmaceutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4923\/14\/4\/842\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:00Z","timestamp":1760136720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4923\/14\/4\/842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,11]]},"references-count":48,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["pharmaceutics14040842"],"URL":"https:\/\/doi.org\/10.3390\/pharmaceutics14040842","relation":{},"ISSN":["1999-4923"],"issn-type":[{"value":"1999-4923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,11]]}}}