Beta-Lactams Dosing In Pneumonia in ICU in Patients Treated by Continuous Renal Replacement Therapy: the BLIPIC Study

Recruiting

• Conditions: Continuous Renal Replacement Therapy; Pneumonia; Beta-lactam; Antibiotic

• Registration Number: NCT03897582
• Lead Sponsor: Centre Hospitalier de Valenciennes

Brief Summary

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.

Detailed Description

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.

This prospective observational multicenter study will include all patients with pneumonia treated by beta-lactam and continuous veino-veinous hemodialysis in 5 ICU. Blood sampling will be done at assumed pharmacokinetic steady state. Protocol sample concentrations of beta-lactams immediately prior to re-dosing, after 24 hours of association of intraveinous beta-lactam and continuous veino-veinous hemodialysis. Another sample will be done after 48 hours. The ICU measured bacterial MICs routinely when the pathogen will be determined. Surveyed ICUs will adopt SFM-EUCAST breakpoints for the targeted (or suspected) bacteria to determine pharmacokinetic/pharmacodynamic targets when a mesured MIC (Minimum inhibitory concentration) is not available. Local hospital antibiogram data can also be used to describe likely pathogen susceptibility. Target attainment is defined as 100% fT\> 5 MIC. Due to the long delay to receive therapeutic drug monitoring results, doses could not be ajusted. Factors which could cause concentrations variations will be registered. When neurotoxicity is suspected, a sample will be realized to know beta-lactam concentration and the adverse event will be notified.

Study Timeline

• Study Start: 2019-02-22
• Study First Submitted: 2019-03-07
• Study First Submitted QC: 2019-03-29
• Study First Posted: 2019-04-01
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-01
• Last Update Posted: 2024-02-02
• Primary Completion: 2026-05-31
• Study Completion: 2026-05-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 65

Inclusion Criteria

• 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

Exclusion Criteria

• Aged < 18 years
• ECMO
• Cystic fibrosis
• Burn victim
• Pregnant woman
• Any rapidly-progressing disease or immediately life-threatening illness
• Objection from the patients or their legally authorised representative
• No social security scheme
• Interruption of antibiotic before samples
• Patient in prison

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Percentage of beta-lactams concentrations above plasma therapeutic levels	Day 3 after start of antibiotic and continuous veino-veinous hemodialysis	We aimed to obtain concentrations over 5 MIC (Minimum inhibitory concentration) for at least 80% of patients.

Secondary Outcome Measures

Name	Time	Method
Incidence of neurotoxicity	Day 7 after start of antibiotic and continuous veino-veinous hemodialysis	Percentage of neurotoxicity
Trends in beta-lactam concentrations between 2 days	At Day 1 and Day 2	Comparaison between 24 hours and 48 hours samples
Clinical response observed when beta-lactam concentrations achieved 5 MIC	At Day 28 and day 90	Survival at Day 28 and Day 90
Distribution of steady state beta-lactam concentrations and their variability	Day 3 after start of antibiotic and continuous veino-veinous hemodialysis	Description of beta-lactam concentration

Trial Locations

Locations (1)

Centre Hospitalier de Valenciennes; 🇫🇷 Valenciennes, Nord, France