Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill.
Erin F Barreto, Marc H Scheetz, Jack Chang...
https://pubmed.ncbi.nlm.nih.gov/40013864/Actively Recruiting
Led by Mayo Clinic · Updated on 2026-02-06
300
Participants Needed
1
Research Sites
17 weeks
Total Duration
Researchers are evaluating two different dosing methods for cefepime, an antibiotic used in very sick patients with sepsis or infection. The study aims to compare the usual dosing approach with a new method that selects doses based on detailed patient information, including kidney function. This trial focuses on how easy it is for healthcare professionals to use the new dosing method and the best way to conduct the study, while also looking at patient recovery and side effects. Participants will be randomly assigned to one of two groups. One group will receive cefepime doses guided by an individualized dosing algorithm that uses estimated kidney function and weight, with recommendations provided through electronic health records and verified by pharmacists. The other group will receive standard care dosing based on institutional guidelines using estimated creatinine clearance categories. Care teams can adjust doses as needed. The study will last one year or until the sample size is reached. During the trial, researchers will monitor how many patients qualify and are distributed across care teams, as well as how well dosing recommendations are followed. Secondary outcomes include antibiotic-free days, ICU length of stay, development of antibiotic resistance, clinical and microbiologic success, and mortality within different time frames. Participants will be closely observed throughout their ICU stay with data collected to assess the impact of the dosing methods.
CONDITIONS
BLOOM: Pragmatic Feasibility Trial
G
Gerald W. Flaby Jr., LRT, RRT
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Mayo Clinic
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Individualized cefepime dosing algorithm (trial arm) | Usual care cefepime dosing (trial arm) | Guideline‑recommended cefepime dosing (external) |
|---|---|---|---|
| What it is | An ICU‑based cefepime dosing algorithm that uses EHR‑prompted recommendations plus ICU pharmacist verification to individualize cefepime dose and interval | Empiric cefepime dosing based on institutional antimicrobial guide using estimated creatinine clearance categories | Standard empiric cefepime dosing in critically ill adults with sepsis as 2 g IV every 8 hours for severe infections when renal function is preserved |
| Role in trial | Investigational intervention being evaluated versus usual care | Active comparator arm reflecting institutional standard practice | Represents typical empiric dosing used in guidelines for cefepime in sepsis |
| Primary use | To improve pharmacokinetic target attainment by individualizing cefepime regimen using EHR and pharmacist support | To deliver empiric cefepime dosing guided by institutional antimicrobial dosing protocol | To provide empiric cefepime therapy at standard regimen for critically ill sepsis patients |
| How it is given or performed | Dose and interval recommended via EHR prompts and verified by ICU pharmacist; care teams may adjust per clinical judgement | Empiric cefepime administered per institutional guide using estimated creatinine clearance categories | Cefepime given intravenously, often 2 g every 8 hours via short infusion, adjusted for renal function |
| Evidence status | Being evaluated in current randomized trial for feasibility and dosing adherence | Established institutional practice without randomized evidence of improved target attainment | Supported by pharmacokinetic modeling and practice guidelines demonstrating standard dosing achieves target concentrations in many critical care patients |
| Important risks | Potential for dosing errors if EHR prompts misalign with rapid renal changes; clinical teams may override | Risk of under‑ or overdosing due to reliance on categorical renal function thresholds | Standard dosing may fail to achieve therapeutic levels in patients with augmented renal clearance or lead to toxicity in rapid kidney dysfunction |
| Important limitations | Feasibility depends on EHR capability and pharmacist availability; may not generalize across settings | Institutional dosing thresholds may not account for patient‑specific pharmacokinetics | Guideline or PK‑based standard dosing may not adapt quickly to acute renal function shifts common in sepsis |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
You may qualify if you...
You will not qualify if you...
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Up to ICU length of stay
Participants receive cefepime dosing either based on an individualized dosing algorithm or usual care dosing by their clinical care team while in the ICU.
Visits as part of routine ICU care
Duration - Up to 28 days post-treatment
Participants are monitored for clinical outcomes including antibiotic-free days, clinical and microbiologic success, resistance development, and mortality.
Follow-up assessments during and after ICU stay
Study Type
INTERVENTIONAL
Masking
SINGLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
2
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Erin F Barreto, Marc H Scheetz, Jack Chang...
https://pubmed.ncbi.nlm.nih.gov/40013864/Mayo Clinic
Lead Sponsor