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Empirical Antibiotic Therapy for Gram-Negative Bacilli Ventilator-Associated Pneumonia: Observational Study and Pharmacodynamic Assessment.
Pajot, Olivier; Lakhal, Karim; Lambert, Jérome; Gros, Antoine; Bruel, Cédric; Boulain, Thierry; Garot, Denis; Das, Vincent; Timsit, Jean François; Cerf, Charles; Souweine, Bertrand; Chaffaut, Cendrine; Mentec, Hervé; Zahar, Jean Ralph; Mira, Jean Paul; Jullien, Vincent.
Afiliación
  • Pajot O; Victor Dupouy Hospital, Intensive Care Unit, F-95100 Argenteuil, France.
  • Lakhal K; Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, F-44093 Nantes, France.
  • Lambert J; Department of Biostatistics and Medical Information, APHP, Saint-Louis Hospital, F-75010 Paris, France.
  • Gros A; Medical-Surgical Intensive Care Unit, André Mignot Hospital, F-78150 Le Chesnay, France.
  • Bruel C; Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, F-75014 Paris, France.
  • Boulain T; Intensive Care Unit, Orleans Regional Hospital, 14 Avenue de L'Hôpital CS 86709, CEDEX 02, F-45067 Orléans, France.
  • Garot D; Service de Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France.
  • Das V; Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, F-93100 Montreuil, France.
  • Timsit JF; AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit (MI2), F-75018 Paris, France.
  • Cerf C; Intensive Care Unit, Foch Hospital, F-92150 Suresnes, France.
  • Souweine B; CHU Clermont-Ferrand, Service de Réanimation Médicale, F-63000 Clermont-Ferrand, France.
  • Chaffaut C; Department of Biostatistics and Medical Information, APHP, Saint-Louis Hospital, F-75010 Paris, France.
  • Mentec H; Victor Dupouy Hospital, Intensive Care Unit, F-95100 Argenteuil, France.
  • Zahar JR; AP-HP, Hôpital Avicenne, Prévention du Risque Infectieux, GH Paris Seine Saint-Denis, F-93000 Bobigny, France.
  • Mira JP; Department of Medical Intensive Care, Cochin University Hospital, F-75014 Paris, France.
  • Jullien V; Pharmacology Unit, University Sorbonne Paris Nord, Groupe Hospitalier Paris Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, F-93140 Bondy, France.
Antibiotics (Basel) ; 11(11)2022 Nov 19.
Article en En | MEDLINE | ID: mdl-36421308
Background: Strong evidence suggests a correlation between pharmacodynamics (PD) index and antibiotic efficacy while dose adjustment should be considered in critically ill patients due to modified pharmacokinetic (PK) parameters and/or higher minimum inhibitory concentrations (MICs). This study aimed to assess pharmacodynamic (PD) target attainment considering both antibiotics serum concentrations and measured MICs in these patients. Method: A multicentric prospective open-label trial conducted in 11 French ICUs involved patients with Gram-negative bacilli (GNB) ventilator-associated pneumonia (VAP) confirmed by quantitative cultures. Results: We included 117 patients. Causative GNBs were P. aeruginosa (40%), Enterobacter spp. (23%), E. coli (20%), and Klebsiella spp. (16%). Hence, 117 (100%) patients received ß-lactams, 65 (58%) aminoglycosides, and two (1.5%) fluoroquinolones. For ß-lactams, 83% of the patients achieved a Cmin/MIC > 1 and 70% had a Cmin/MIC > 4. In the case of high creatinine clearance (CrCL > 100 mL/min/1.73 m2), 70.4% of the patients achieved a Cmin/MIC ratio > 1 versus 91% otherwise (p = 0.041), and 52% achieved a Cmin/MIC ratio > 4 versus 81% (p = 0.018). For aminoglycosides, 94% of the patients had a Cmax/MIC ratio > 8. Neither ß-lactams nor aminoglycosides PK/PD parameters were associated clinical outcomes, but our data suggest a correlation between ß-lactams Cmin/MIC and microbiological success. Conclusion: In our ICU patients treated for GNB VAP, using recommended antibiotic dosage led in most cases to PK/PD targets attainment for aminoglycosides and ß-lactams. High creatinine clearance should encourage clinicians to focus on PK/PD issues.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Idioma: En Revista: Antibiotics (Basel) Año: 2022 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Idioma: En Revista: Antibiotics (Basel) Año: 2022 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Suiza