Continuous infusion of beta-lactam antibiotics in pediatric intensive care unit: A monocenter before/after implementation study.
Anaesth Crit Care Pain Med
; 43(3): 101354, 2024 Jun.
Article
en En
| MEDLINE
| ID: mdl-38360404
ABSTRACT
CONTEXT Beta-lactam continuous infusion (CI) is currently recommended in adult intensive care units to achieve target concentrations. In pediatric intensive care (PICU), few studies suggest the value of Beta-lactam CI to achieve target concentration. Our objective was to analyze the impact of Beta-lactam CI protocolization on the achievement of target concentration in PICU patients. MATERIAL AND METHODS:
We conducted a single-center retrospective study in patients with beta-lactam treatment for more than 2 days and at least one sample for therapeutic drug monitoring (TDM). From January 2018 to February 2022 (period 1, P1), BL were administered as an intermittent infusion with TDM upon request. From February to September 2022 (period 2, P2), Beta-lactam CI with TDM at day one was protocolized. The primary endpoint concerned achieving fT>4× Minimum Inhibitory Concentration = 100%.RESULTS:
In P1, 214 assays involved 103 patients; in P2, 199 assays involved 72 patients. Target concentration achievement was more frequent in P2 (P2 = 73.7% vs. P1 = 29.1%; p < 0.001). At day 5/6 after Beta-lactam initiation, c-reactive protein concentrations were P1 = 84.9 ± 79.2 mg/L; P2 = 53.7±49.8 mg/L (p < 0.05). In the multivariable logistic regression model P2, BSA, and albumin were positively associated with target achievement; urea, and male sex were negatively associated with target achievement. The daily average cost of beta-lactam vial consumption per child was P1 = 5.04 ± 2.6 ; vs. P2 = 3.21 ± 2.7 ; (p-value < 0.001). The daily average reconstitution time of Beta-lactam syringes per child was P1 = 23.5 ± 8.7 min, P2 = 13.9 ± 9.2 min (p-value < 0.001).CONCLUSION:
Protocolization of Beta-lactam continuous infusion was associated with more frequent target concentration achievements in PICU. This implementation could be cost-effective and nurse time-saving.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Unidades de Cuidado Intensivo Pediátrico
/
Monitoreo de Drogas
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Beta-Lactamas
/
Antibacterianos
Tipo de estudio:
Guideline
/
Observational_studies
/
Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
/
Female
/
Humans
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Infant
/
Male
Idioma:
En
Revista:
Anaesth Crit Care Pain Med
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Francia