000363 An international survey on aminoglycoside practices in critically ill patients: The AMINO III study
Published Date: 19th September 2019
Publication Authors: Barton G
INTRODUCTION
The optimal dosing strategy of aminoglycosides (AG) remains debated in intensive care units (ICUs).
OBJECTIVES
We investigated the international practices of AG regarding dosing and therapeutic drug monitoring in ICU patients.
METHODS
A prospective, multicentre, observational, cohort study was conducted in 59 intensive care units (ICUs) across 5 countries. All patients admitted to the ICU and receiving AG therapy for septic shock were included in the present study.
RESULTS
We enrolled 931 patients (mean +/- standard deviation (SD), age 63 +/- 15 years, female 364 (39%), median SAPS II 51 ((interquartile (IQR):38-65)) receiving AG as part of empirical (761, 84%) or directed (147, 16%) antimicrobial therapy for sepsis or septic shock. The AG used was amikacin in 625 (67%), gentamicin in 312 (34%) and tobramycin in 15 (2%) patients. Aminoglycosides were mainly used for pulmonary (405, 44%), abdominal (233 (25%), urinary (126 (14%) infections and bacteremia (158, 17.0%). Aminoglycoside resistance was reported in 58 (18%) of documented infections. The median duration of therapy was 2 ((IQR 1-3) days, the median number of AG doses was 2 ((IQR 1-2), the mean dose was 25 +/- 6, 6 +/- 2, 6 +/- 1.6 mg/kg of total body weight for amikacin, gentamicin and tobramycin respectively, and the median dosing interval was 26 (IQR 23.5- 43.5) h. Proportion of changes in median serum creatinine levels during AG therapy were -7% (IQR-24%; 12%). Therapeutic drug monitoring (TDM) of peak and trough concentrations was performed in 445 (48%) and 501 (57%) patients after the first dose. After the first AG dose, only 250 (56%) patients achieved the PK/PD target of Cmax/MIC >8 and 336 (67%) had concentrations above Cmin recommended thresholds. The ICU mortality rate was 27.3% with multivariable analysis showing AG resistant isolate (OR 8.31, 95% CI: 1.31- 78.30, p=0.0355), SOFA score (OR 1.54, 95% CI: 1.24-2.03, p=0.0004) and directed antimicrobial therapy (OR 0.08, 95% CI: 0.01-0.70, p= 0.0254) as independent predictors of ICU mortality. We could show no correlation between AG dosing or PK/PD target attainment and clinical outcomes (Table 1)
CONCLUSION
Short courses of high AG doses are mainly used in ICU patients with septic shock although wide variability in AG practices is reported. Efforts to optimize the first AG dose and to perform TDM are still needed. (Figure Presented).
Roger, C; Barton, G et al. (2019). 000363 An international survey on aminoglycoside practices in critically ill patients: The AMINO III study. Intensive Care Medicine Experimental. 7, 55