Pneumonia are the most frequent infections in ICU. Little is known about beta-lactam doses necessary for this infection for patients treated with continuous veino-veinous hemodialysis. The pharmacokinetic variability expose to over and underdosage leading to toxicity or therapeutic failure. The aim of this study is to define if beta-lactams doses used in pneumonia for patients with acute kidney injury treated with our hemodialysis conditions lead to beta-lactam therapeutic plasma levels.
Pneumonia are the most frequent infections in ICU. Little is known about beta-lactam doses necessary for this infection for patients treated with continuous veino-veinous hemodialysis. The pharmacokinetic variability expose to over and underdosage leading to toxicity or therapeutic failure. The aim of this study is to define if beta-lactams doses used in pneumonia for patients with acute kidney injury treated with our hemodialysis conditions lead to beta-lactam therapeutic plasma levels. This prospective observational multicenter study will include all patients with pneumonia treated by beta-lactam and continuous veino-veinous hemodialysis in 5 ICU. Blood sampling will be done at assumed pharmacokinetic steady state. Protocol sample concentrations of beta-lactams immediately prior to re-dosing, after 24 hours of association of intraveinous beta-lactam and continuous veino-veinous hemodialysis. Another sample will be done after 48 hours. The ICU measured bacterial MICs routinely when the pathogen will be determined. Surveyed ICUs will adopt SFM-EUCAST breakpoints for the targeted (or suspected) bacteria to determine pharmacokinetic/pharmacodynamic targets when a mesured MIC (Minimum inhibitory concentration) is not available. Local hospital antibiogram data can also be used to describe likely pathogen susceptibility. Target attainment is defined as 100% fT\> 5 MIC. Due to the long delay to receive therapeutic drug monitoring results, doses could not be ajusted. Factors which could cause concentrations variations will be registered. When neurotoxicity is suspected, a sample will be realized to know beta-lactam concentration and the adverse event will be notified.
Study Type
OBSERVATIONAL
Enrollment
65
Centre Hospitalier de Valenciennes
Valenciennes, Nord, France
RECRUITINGPercentage of beta-lactams concentrations above plasma therapeutic levels
We aimed to obtain concentrations over 5 MIC (Minimum inhibitory concentration) for at least 80% of patients.
Time frame: Day 3 after start of antibiotic and continuous veino-veinous hemodialysis
Distribution of steady state beta-lactam concentrations and their variability
Description of beta-lactam concentration
Time frame: Day 3 after start of antibiotic and continuous veino-veinous hemodialysis
Incidence of neurotoxicity
Percentage of neurotoxicity
Time frame: Day 7 after start of antibiotic and continuous veino-veinous hemodialysis
Trends in beta-lactam concentrations between 2 days
Comparaison between 24 hours and 48 hours samples
Time frame: At Day 1 and Day 2
Clinical response observed when beta-lactam concentrations achieved 5 MIC
Survival at Day 28 and Day 90
Time frame: At Day 28 and day 90
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