[Monitoring aminoglycosides in an Intensive Care Unit].
OBJECTIVE
This monocentric, observational and retrospective survey was performed to check the appropriateness between aminoglycoside prescriptions and inhibitor quotient to be reached, in Intensive Care Unit (ICU) patients. We identified variability factors for aminoglycoside plasmatic concentrations at peak such as standardized index of gravity (IGS2 scale), age, sex, weight, and severity of sepsis.


METHODS
Eighty-seven ICU patients received an antibiotic combination mandatorily including an aminoglycoside (amikacin or gentamicin) as curative treatment for a severe infection. Prescribed dosages were 15mg/kg for amikacin and 5mg/kg for gentamicin. The maximal concentration (Cmax) and minimal inhibiting concentration (MIC) of involved bacteria were recorded. The aminoglycoside ratio Cmax/MIC, called inhibitor quotient, was determined. The inhibitor quotient was considered efficient when superior to 10. The Cmax for aminoglycoside first peak was also compared with the theoretical Cmax to be reached.


RESULTS
In the aminoglycoside Cmax, 50.3% were efficient (59.6% for amikacin Cmax and 38.9% for gentamicin Cmax). In 46% of the cases, the inhibitor quotient was efficient; 12.6% of Cmax reached the theoretical Cmax. Factors identified as negatively interacting with biological efficiency were: Gram-positive bacteria or anaerobic bacteria infections and planned surgery.


CONCLUSIONS
In the inhibitor quotients, 49.7% were at inefficient rates, even when the recommended aminoglycoside dosage for was given. Therefore, dose and administration should be updated.
Département anesthésie-réanimation-urgences, hôpital d'instruction des armées Clermont-Tonnerre, rue du Colonel-Fontferrier, Brest-Armées, France. diane.commandeur@wanadoo.fr
D
D
Commandeur
S
S
Eyrieux
A
A
Le Noël
V B
VB
Nguyen
C
C
Giacardi
M
M
Danguy des Déserts
M-L
ML
Buguet-Brown
I
I
Drouillard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000097:blood* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000627:therapeutic use; D016903:Drug Monitoring; D005260:Female; D005839:Gentamicins / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000583:Amikacin