التفاصيل البيبلوغرافية
| العنوان: |
Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen. |
| المؤلفون: |
Montmollin, Etienne, Bouadma, Lila, Gault, Nathalie, Mourvillier, Bruno, Mariotte, Eric, Chemam, Sarah, Massias, Laurent, Papy, Emmanuelle, Tubach, Florence, Wolff, Michel, Sonneville, Romain |
| المصدر: |
Intensive Care Medicine; Jul2014, Vol. 40 Issue 7, p998-1005, 8p |
| مصطلحات موضوعية: |
PHARMACODYNAMICS, AMINOGLYCOSIDES, SERUM, CRITICALLY ill, CRITICAL care medicine, INTRAVENOUS injections, SEPSIS |
| مستخلص: |
Purpose: Amikacin requires pharmacodynamic targets of peak serum concentration ( C) of 8-10 times the minimal inhibitory concentration, corresponding to a target C of 60-80 mg/L for the less susceptible bacteria. Even with new dosing regimens of 25 mg/kg, 30 % of patients do not meet the pharmacodynamic target. We aimed to identify predictive factors for insufficient C in a population of critically ill patients. Methods: Prospective observational monocentric study of patients admitted to a general ICU and requiring a loading dose of amikacin. Amikacin was administered intravenously at the dose of 25 mg/kg of total body weight. Independent determinants of C < 60 mg/L were identified by mixed model multivariate analysis. Results: Over a 1-year period, 181 episodes in 146 patients (SAPS 2 = 51 [41-68]) were included. At inclusion, the SOFA score was 8 [6-12], 119 (66 %) episodes required vasopressors, 150 (83 %) mechanical ventilation, and 81 (45 %) renal replacement therapy. The amikacin C was 69 [54.9-84.4] mg/L. Overall, 60 (33 %) episodes had a C < 60 mg/L. The risk of C < 60 mg/L associated with BMI < 25 kg/m varied across quarters of inclusion. Independent risk factors for C < 60 mg/L were a BMI < 25 kg/m over the first quarter (odds ratio (OR) 15.95, 95 % confidence interval (CI) [3.68-69.20], p < 0.001) and positive 24-h fluid balance (OR per 250-mL increment 1.06, 95 % [CI 1.01-1.11], p = 0.018). Conclusions: Despite an amikacin dose of 25 mg/kg of total body weight, 33 % of patients still had an amikacin C < 60 mg/L. Positive 24-h fluid balance was identified as a predictive factor of C < 60 mg/L. When total body weight is used, low BMI tended to be associated with amikacin underdosing. These results suggest the need for higher doses in patients with a positive 24-h fluid balance in order to reach adequate therapeutic targets. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
