Beta-Lactams Dosing In Pneumonia in ICU in Patients Treated by Continuous Renal Replacement Therapy
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.
• Aged ≥ 18 years
• Receiving intraveinous beta-lactam : amoxicillin, amoxicillin-clavulanic acid, piperacillin-tazobactam, cefotaxime, ceftazidime, cefepime, meropenem, imipenem
• With AKI defined as any of the following, and treated with Multifiltrate Ci-Ca CVVHD 1000® kit with a dialysis dose of 25 ml/kg/h :
‣ Increase in creatininemia ≥ 0.3 mg/dl (≥ 26.5 µmol/l) within 48 hours
⁃ Increase in creatininemia ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days
⁃ Urine volume \< 0.5 ml/kg/h for 6 hours
• Hospitalized in ICU
• Presence of a catheter to facilitate sample collection
• With pneumonia defined as any of the following :
‣ Chest X-ray pneumonia : opacities, new or progressive infiltrates
⁃ AND at least one of the following : hyperthermia \> 38°C or hypothermia \< 36°C with no other explanation ; leukopenia \< 4 G/L ou leukocytosis \> 12G/L
⁃ AND at least one of the following : new onset purulent sputum or change in sputum character, new onset or worsening cough or dyspnea or tachypnea, rales or bronchial breathing, lower oxygen saturation/hypoxemia or increase of oxygen needs or respiratory assistance
• Treated within 24 hours by citrate hemodialysis AND beta-lactam respecting dose and administration conditions of the study :
‣ Amoxicillin : loading dose followed immediately by 2g by extended infusion for 4 hours every 8 hours
⁃ Amoxicillin-clavulanic acid : 2g every 8 hours by intermittent bolus
⁃ Piperacillin-tazobactam: loading dose followed immediately by 4g/0.5g by continuous infusion every 8 hours (\< 80 kg) ou 6 hours (\> 80 kg)
⁃ Cefotaxime: loading dose followed immediately by 2g by continuous infusion every 8 hours Ceftazidime : loading dose followed immediately by 2g by continuous infusion every 8 hours
⁃ Cefepime: loading dose followed immediately by 2g by continuous infusion every 8 hours
⁃ Meropenem : loading dose followed immediately by 2g (\> 60 kg) ou 1,33g (\< 60 kg) by extended infusion for 4 hours every 8 hours
⁃ Imipenem : loading dose followed immediately by 750 mg (\< 80 kg) ou 1g (\> 80 kg) by extended infusion for 4 hours every 6 hours In case of extrem weight, dose will be on investigator's discretion but administration conditions have be to respected.
• No objection has been obtained from the patient or their legally authorised representative