Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial
Abstract Background Sepsis prognosis correlates with antibiotic adequacy at the early phase. This adequacy is dependent on antibacterial spectrum, bacterial resistance profile and antibiotic dosage. Optimal efficacy of beta-lactams mandates concentrations above the minimal inhibitory concentration (...
| প্রধান লেখক: | , , , , , , , , , , , , , , , , , |
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| বিন্যাস: | প্রবন্ধ |
| ভাষা: | English |
| প্রকাশিত: |
SpringerOpen
2023-02-01
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| মালা: | Annals of Intensive Care |
| বিষয়গুলি: | |
| অনলাইন ব্যবহার করুন: | https://doi.org/10.1186/s13613-023-01105-0 |
| _version_ | 1827982787017179136 |
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| author | Damien Roux Nicolas Benichou David Hajage Laurent Martin-Lefèvre Nicolas de Prost Nicolas Lerolle Dimitri Titeca-Beauport Eric Boulet Julien Mayaux Bruno Mégarbane Khaoula Mahjoub Dorothée Carpentier Saad Nseir Florence Tubach Jean-Damien Ricard Didier Dreyfuss Stéphane Gaudry for the AKIKI Study group |
| author_facet | Damien Roux Nicolas Benichou David Hajage Laurent Martin-Lefèvre Nicolas de Prost Nicolas Lerolle Dimitri Titeca-Beauport Eric Boulet Julien Mayaux Bruno Mégarbane Khaoula Mahjoub Dorothée Carpentier Saad Nseir Florence Tubach Jean-Damien Ricard Didier Dreyfuss Stéphane Gaudry for the AKIKI Study group |
| author_sort | Damien Roux |
| collection | DOAJ |
| description | Abstract Background Sepsis prognosis correlates with antibiotic adequacy at the early phase. This adequacy is dependent on antibacterial spectrum, bacterial resistance profile and antibiotic dosage. Optimal efficacy of beta-lactams mandates concentrations above the minimal inhibitory concentration (MIC) of the targeted bacteria for the longest time possible over the day. Septic acute kidney injury (AKI) is the most common AKI syndrome in ICU and often mandates renal replacement therapy (RRT) initiation. Both severe AKI and RRT may increase outside target antibiotic concentrations and ultimately alter patient’s prognosis. Patients and methods This is a secondary analysis of a randomized controlled trial that compared an early RRT initiation strategy with a delayed one in 620 critically ill patients undergoing severe AKI (defined by KDIGO 3). We compared beta-lactam trough concentrations between the two RRT initiation strategies. The primary outcome was the proportion of patients with sufficient trough plasma concentration of beta-lactams defined by trough concentration above 4 times the MIC. We hypothesized that early initiation of RRT could be associated with an insufficient antibiotic plasma trough concentration compared to patients allocated to the delayed strategy. Results One hundred and twelve patients were included: 53 in the early group and 59 in the delayed group. Eighty-three patients (74%) had septic shock on inclusion. Trough beta-lactam plasma concentration was above 4 times the MIC breakpoint in 80.4% (n = 90) of patients of the whole population, without differences between the early and the delayed groups (79.2% vs. 81.4%, respectively, p = 0.78). On multivariate analysis, the presence of septic shock and a higher mean arterial pressure were significantly associated with a greater probability of adequate antibiotic trough concentration [OR 3.95 (1.14;13.64), p = 0.029 and OR 1.05 (1.01;1.10), p = 0.013, respectively). Evolution of procalcitonin level and catecholamine-free days as well as mortality did not differ whether beta-lactam trough concentration was above 4 times the MIC or not. Conclusions In this secondary analysis of a randomized controlled trial, renal replacement therapy initiation strategy did not significantly influence plasma trough concentrations of beta-lactams in ICU patients with severe AKI. Presence of septic shock on inclusion was the main variable associated with a sufficient beta-lactam concentration. Trial registration: The AKIKI trial was registered on ClinicalTrials.gov (Identifier: NCT01932190) before the inclusion of the first patient. |
| first_indexed | 2024-04-09T22:38:49Z |
| format | Article |
| id | doaj.art-f9e80591231c4beb83431200c19ef28c |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-09T22:38:49Z |
| publishDate | 2023-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-f9e80591231c4beb83431200c19ef28c2023-03-22T12:22:12ZengSpringerOpenAnnals of Intensive Care2110-58202023-02-011311810.1186/s13613-023-01105-0Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trialDamien Roux0Nicolas Benichou1David Hajage2Laurent Martin-Lefèvre3Nicolas de Prost4Nicolas Lerolle5Dimitri Titeca-Beauport6Eric Boulet7Julien Mayaux8Bruno Mégarbane9Khaoula Mahjoub10Dorothée Carpentier11Saad Nseir12Florence Tubach13Jean-Damien Ricard14Didier Dreyfuss15Stéphane Gaudry16for the AKIKI Study groupDMU ESPRIT, Service de Médecine Intensive Réanimation, AP-HP, Université Paris Cité, Hôpital Louis MourierDMU ESPRIT, Service de Médecine Intensive Réanimation, AP-HP, Université Paris Cité, Hôpital Louis MourierDépartement de Santé Publique, Centre de Pharmacoépidémiologie (Céphépi), Unité de Recherche Clinique PSL-CFX, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié SalpêtrièreRéanimation Polyvalente, Centre Hospitalier Départemental - Site de La Roche-Sur-YonRéanimation Médicale, AP-HP, Hôpital Henri MondorDépartement de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d’AngersBoRealStudy Group, Medical Intensive Care Unit and EA7517, Amiens University HospitalVal d’Oise, Hôpital René DubosMédecine Intensive Réanimation, AP-HP, Hôpital Pitié-SalpétrièreDepartment of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris CitéService de Réanimation, Hôpital DelafontaineMédecine Intensive Réanimation, Centre Hospitalier Universitaire RouenCentre Médecine Intensive-Réanimation, CHU de Lille and INSERM U1285, Université de Lille, CNRS, UMR 8576-UGSFDépartement de Santé Publique, Centre de Pharmacoépidémiologie (Céphépi), Unité de Recherche Clinique PSL-CFX, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié SalpêtrièreDMU ESPRIT, Service de Médecine Intensive Réanimation, AP-HP, Université Paris Cité, Hôpital Louis MourierDMU ESPRIT, Service de Médecine Intensive Réanimation, AP-HP, Université Paris Cité, Hôpital Louis MourierSorbonne Université, INSERM Unit S_1155 CORAKIDAbstract Background Sepsis prognosis correlates with antibiotic adequacy at the early phase. This adequacy is dependent on antibacterial spectrum, bacterial resistance profile and antibiotic dosage. Optimal efficacy of beta-lactams mandates concentrations above the minimal inhibitory concentration (MIC) of the targeted bacteria for the longest time possible over the day. Septic acute kidney injury (AKI) is the most common AKI syndrome in ICU and often mandates renal replacement therapy (RRT) initiation. Both severe AKI and RRT may increase outside target antibiotic concentrations and ultimately alter patient’s prognosis. Patients and methods This is a secondary analysis of a randomized controlled trial that compared an early RRT initiation strategy with a delayed one in 620 critically ill patients undergoing severe AKI (defined by KDIGO 3). We compared beta-lactam trough concentrations between the two RRT initiation strategies. The primary outcome was the proportion of patients with sufficient trough plasma concentration of beta-lactams defined by trough concentration above 4 times the MIC. We hypothesized that early initiation of RRT could be associated with an insufficient antibiotic plasma trough concentration compared to patients allocated to the delayed strategy. Results One hundred and twelve patients were included: 53 in the early group and 59 in the delayed group. Eighty-three patients (74%) had septic shock on inclusion. Trough beta-lactam plasma concentration was above 4 times the MIC breakpoint in 80.4% (n = 90) of patients of the whole population, without differences between the early and the delayed groups (79.2% vs. 81.4%, respectively, p = 0.78). On multivariate analysis, the presence of septic shock and a higher mean arterial pressure were significantly associated with a greater probability of adequate antibiotic trough concentration [OR 3.95 (1.14;13.64), p = 0.029 and OR 1.05 (1.01;1.10), p = 0.013, respectively). Evolution of procalcitonin level and catecholamine-free days as well as mortality did not differ whether beta-lactam trough concentration was above 4 times the MIC or not. Conclusions In this secondary analysis of a randomized controlled trial, renal replacement therapy initiation strategy did not significantly influence plasma trough concentrations of beta-lactams in ICU patients with severe AKI. Presence of septic shock on inclusion was the main variable associated with a sufficient beta-lactam concentration. Trial registration: The AKIKI trial was registered on ClinicalTrials.gov (Identifier: NCT01932190) before the inclusion of the first patient.https://doi.org/10.1186/s13613-023-01105-0Acute kidney injuryBeta-lactamConcentrationSeptic shockRenal replacement therapyAntibiotic |
| spellingShingle | Damien Roux Nicolas Benichou David Hajage Laurent Martin-Lefèvre Nicolas de Prost Nicolas Lerolle Dimitri Titeca-Beauport Eric Boulet Julien Mayaux Bruno Mégarbane Khaoula Mahjoub Dorothée Carpentier Saad Nseir Florence Tubach Jean-Damien Ricard Didier Dreyfuss Stéphane Gaudry for the AKIKI Study group Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial Annals of Intensive Care Acute kidney injury Beta-lactam Concentration Septic shock Renal replacement therapy Antibiotic |
| title | Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial |
| title_full | Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial |
| title_fullStr | Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial |
| title_full_unstemmed | Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial |
| title_short | Impact of renal replacement therapy strategy on beta-lactam plasma concentrations: the BETAKIKI study—an ancillary study of a randomized controlled trial |
| title_sort | impact of renal replacement therapy strategy on beta lactam plasma concentrations the betakiki study an ancillary study of a randomized controlled trial |
| topic | Acute kidney injury Beta-lactam Concentration Septic shock Renal replacement therapy Antibiotic |
| url | https://doi.org/10.1186/s13613-023-01105-0 |
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