PK/PD targets of amikacin and gentamicin in ICU patients - 07/11/20
Objectifs PK/PD pour l’amikacine et la gentamicine en réanimation
, G. Deslandes c, L. Jalin d, S. Corvec e, j, J. Caillon e, f, D. Boutoille f, g, M. Grégoire c, h, C. Bretonnière f, iBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
| pages | 6 |
| Iconographies | 0 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | PK targets were achieved in 59.6% of ICU patients for amikacin and in 2.2% of ICU patients for gentamicin. |
• | Factors associated with PK target achievement were dose per kg and renal clearance. |
• | PK/PD targets were achieved for all patients infected with susceptible bacteria. |
Abstract |
Objectives |
We aimed to evaluate the probability to achieve PK-PD targets in patients with sepsis hospitalized in the intensive care unit (ICU) after a single dose of 30mg/kg of amikacin or 8mg/kg of gentamicin.
Patients and methods |
This single-center prospective study included 138 ICU patients with severe sepsis or septic shock with an indication for intravenous amikacin (N=89) or gentamicin (N=49). Maximum concentration (Cmax) was measured 30 minutes after infusion completion. PK/PD objectives were respectively Cmax≥60mg/L and ≥30mg/L for amikacin and gentamicin for empirical therapy, and a Cmax/MIC ratio≥8, as per French guidelines.
Results |
The median Simplified Acute Physiology Score II was 43 and ICU case fatality rate was 34.8%. A causative bacterial agent was identified in 94 patients (68.1%). Three pathogens had acquired aminoglycoside resistance and 15 were naturally resistant. The targeted Cmax for the first dose was achieved in 53 patients (59.6%) receiving amikacin, and one (2.2%) patient receiving gentamicin. Cmax/MIC ratio≥8 was obtained in all patients infected with susceptible pathogens (N=72). Factors associated with Cmax≥60mg/L of amikacin in multivariate analysis were dose per kg of adapted body weight (OR=1.39, P<0.001) and renal clearance estimated with CKD-EPI formula (OR=0.98, P=0.003).
Conclusions |
Despite high doses, amikacin and gentamicin first Cmax remain dramatically low in ICU patients. However, an adequate Cmax/MIC ratio was reached in all patients.
Le texte complet de cet article est disponible en PDF.Keywords : Amikacin, Gentamicin, PK/PD, Intensive care unit
Plan
Vol 50 - N° 8
P. 709-714 - novembre 2020 Retour au numéro
Article précédent
- Implant retention and high rate of treatment failure in hematogenous acute knee and hip prosthetic joint infections
- N. Pansu, M. Hamoui, F. Manna, A. Makinson, S. Dufour, D. Morquin, F. Canovas, J. Reynes, V. Le Moing
- Emerging extensively drug-resistant bacteria (eXDR) in France in 2018
- M. Colomb-Cotinat, S. Soing-Altrach, A. Leon, Y. Savitch, I. Poujol, T. Naas, V. Cattoir, A. Berger-Carbonne, L. Dortet, the CPIAS network
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’achat d’article à l’unité est indisponible à l’heure actuelle.
Déjà abonné à cette revue ?