Aminoglycosides in Critically Ill Septic Patients With Acute Kidney Injury Receiving Continuous Renal Replacement Therapy: A Multicenter, Observational Study
| العنوان: | Aminoglycosides in Critically Ill Septic Patients With Acute Kidney Injury Receiving Continuous Renal Replacement Therapy: A Multicenter, Observational Study |
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| المؤلفون: | Arthur Orieux, Thuy-Nga Phan, Sébastien Rubin, Alexandre Lautrette, Bertrand Souweine, Julien Bohé, Alexandre Boyer, Didier Gruson, Kada Klouche, Emmanuel Canet, Jean-François Timsit |
| المساهمون: | Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) |
| المصدر: | Clinical Therapeutics Clinical Therapeutics, Elsevier, 2021, ⟨10.1016/j.clinthera.2021.04.011⟩ |
| بيانات النشر: | HAL CCSD, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Adult, Continuous Renal Replacement Therapy, Critical Illness, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Cmax, Placebo, 03 medical and health sciences, Cmin, 0302 clinical medicine, Interquartile range, Sepsis, Intensive care, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Renal replacement therapy, ComputingMilieux_MISCELLANEOUS, Pharmacology, 0303 health sciences, 030306 microbiology, business.industry, Acute kidney injury, Acute Kidney Injury, medicine.disease, 3. Good health, Renal Replacement Therapy, Aminoglycosides, Amikacin, Anesthesia, business, medicine.drug |
| الوصف: | Purpose Data on aminoglycoside stewardship in critically ill septic patients with acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT) are scarce. The objectives of the study were to determine, during CRRT, the time window with low likelihood for safe reinjection and the proportion of inappropriate reinjection. Methods A post hoc observational analysis of a multicenter randomized trial comparing the risk of hemodialysis catheter infection with ethanol lock vs placebo in critically ill patients with AKI was conducted. Eligible patients were adults in intensive care units from 6 French hospitals. Any patient with AKI needing CRRT and receiving an antimicrobial therapy for a septic episode occurring before (≤24 hours) or during CRRT was included. The aminoglycoside orders were left to the physicians’ discretion, but high dose once daily was the schedule of aminoglycoside administration. Findings A total of 145 septic episodes treated by aminoglycosides were analyzed in patients receiving CRRT. A mean (SD) of 1.6 (0.8) amikacin and 1.8 (1.2) gentamicin administrations per patient were observed. During CRRT, Cmax was 17.3 mg/L (interquartile range, 13.2-22.5 mg/L) for gentamicin and 50 mg/L (interquartile range, 43.7-76.6 mg/L) for amikacin. The plasma drug concentration at 24 hours (CH24) was 2.3 mg/L (interquartile range, 1.6-3.2 mg/L) for gentamicin and 9.3 (interquartile range, 6.6-12.0 mg/L) for amikacin. Sixty-five Cmin dosages remained above the reinjection threshold. Inappropriate reinjection was observed in 11 of 65 episodes (17%). Inappropriate reinjection (defined by, at the reinjection time, Cmin dosages above the threshold; ie, Cmin >2 mg/L for gentamicin and >5 mg/L for amikacin) was observed in 17% of analyzed episodes. Most patients did not need reinjection until approximately ≥30 hours after their initial administration. Implications During CRRT, as indicated by the CH24 value, which was higher than the recommended threshold, the interval to obtain a Cmin low enough to allow for redosing aminoglycosides is significantly longer than 24 hours. This interval is not always respected and leads to an of inappropriate reinjection rate of 17%. ClinicalTrials.gov identifier: ISRCTNCT00875069. |
| اللغة: | English |
| تدمد: | 0149-2918 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7eb873593ed11f97043562b9e8a89410Test https://hal.archives-ouvertes.fr/hal-03258712/documentTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....7eb873593ed11f97043562b9e8a89410 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 01492918 |
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