Aminoglycosides in Critically Ill Septic Patients With Acute Kidney Injury Receiving Continuous Renal Replacement Therapy: A Multicenter, Observational Study

Purpose Data on aminoglycoside stewardship in critically ill septic patients with acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT) are scarce. The objectives of the study were to determine, during CRRT, time window low likelihood for safe reinjection and proportion inappropriate reinjection. Methods A post hoc observational analysis a multicenter randomized trial comparing risk hemodialysis catheter infection ethanol lock vs placebo AKI was conducted. Eligible adults intensive care units from 6 French hospitals. Any patient CRRT receiving an antimicrobial episode occurring before (≤24 hours) or included. orders left physicians’ discretion, but high dose once daily schedule administration. Findings total 145 episodes treated by aminoglycosides analyzed CRRT. mean (SD) 1.6 (0.8) amikacin 1.8 (1.2) gentamicin administrations per observed. During Cmax 17.3 mg/L (interquartile range, 13.2-22.5 mg/L) 50 43.7-76.6 amikacin. plasma drug concentration at 24 hours (CH24) 2.3 1.6-3.2 9.3 6.6-12.0 Sixty-five Cmin dosages remained above threshold. Inappropriate observed 11 65 (17%). (defined by, time, threshold; ie, >2 >5 amikacin) 17% episodes. Most did not need until approximately ≥30 after their initial Implications as indicated CH24 value, which higher than recommended threshold, interval obtain enough allow redosing is significantly longer hours. This always respected leads rate 17%. ClinicalTrials.gov identifier: ISRCTNCT00875069.