par Brasseur, Alexandre 
;Hites, Maya ;Roisin, Sandrine ;Cotton, Frédéric ;Vincent, Jean Louis ;De Backer, Daniel ;Jacobs, Frédérique ;Taccone, Fabio
Référence Journal of antimicrobial chemotherapy, 71, 5, page (1386-1394), dkv491
Publication Publié, 2016-05
;Hites, Maya ;Roisin, Sandrine ;Cotton, Frédéric ;Vincent, Jean Louis ;De Backer, Daniel ;Jacobs, Frédérique ;Taccone, Fabio Référence Journal of antimicrobial chemotherapy, 71, 5, page (1386-1394), dkv491
Publication Publié, 2016-05
Article révisé par les pairs
| Résumé : | Background: Infections caused by MDR Gram-negative (GN) organisms in critically ill patients are a therapeutic challenge. The administration of high-dose aminoglycoside (HDA) therapy coupled with high-flow continuous veno-venous haemodiafiltration (CVVHDF) could allow required high drug peaks to be achieved with acceptable drug elimination. Methods: All adult patients present on the ICU between October 2009 and July 2014 who had MDR GN sepsis were considered for HDA and high-flow (>45 mL/kg/h) CVVHDF when an isolated pathogen was susceptible or had intermediate susceptibility to aminoglycosides and the patient's condition was not improving with conventional therapy. Optimal antibacterial activity was defined as a peak concentration of at least eight times the MIC. Results: Fifteen patients infected with MDR GN pathogens (11 with Pseudomonas aeruginosa; 10 with abdominal infections and 5 with respiratory infections) were treated with amikacin (n=11), gentamicin (n=3) or tobramycin (n=1) and high-flowCVVHDF. A favourable clinical responsewas observed in eight (53%) patients, including three in whom microbial eradication was obtained. Six patients were discharged alive from the ICU, and five from the hospital. No renal toxicity was observed among survivors. Conclusion: In this cohort of septic patients with MDR GN infections, HDA combined with high-flow CVVHDF represented a valuable therapeutic option. The effectiveness of this approach should be further evaluated in larger studies. |
