Pernod Cyril, Lamblin Antoine, Cividjian Andrei, Gerome Patrick, Pierre-François Wey
Department of Anesthesiology and Intensive care medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Statistical Unit, Desgenettes Military Teaching Hospital, Lyon, France.
Turk J Anaesthesiol Reanim. 2020 Oct;48(5):399-405. doi: 10.5152/TJAR.2019.57255. Epub 2019 Dec 26.
Numerous cases of gentamicin underdosing have been described in the literature in the context of sepsis and septic shock in anaesthesia-intensive care units (ICU). A survey of clinical practice was conducted with the aim to rationalise the use of gentamicin in the unit. The secondary objective was to propose a corrective formula for adjusting individual dosage.
A single-centre survey was used to determine the initial dose of gentamicin administered, in an anaesthesia-ICU, during the first hours of sepsis/septic shock. An initial retrospective phase allowed focusing on the points of improvement in terms of prescription. A second prospective phase enabled the evaluation of benefits following the implemented changes.
Fifty-one patients were included during the retrospective phase (2014-2015) and 28 patients during the prospective phase (2016-2017). Out-of-guideline prescriptions significantly decreased between these two study periods (i.e., pulmonary infections decreased from 70.5% to 18%, p<0.001) and the mean±standard deviation administered dosage increased from 7.3±1.2 mg kg to 9.5±1.5 mg kg (p<0.001). Nevertheless, the proportion of Cmax (peak plasma concentration) ≥30 mg L and the mean Cmax did not change significantly. A significant association (p<0.05) was found between Cmax, body mass index, haematocrit and creatinine, enabling a corrective formula to be proposed.
The present study allowed improvement in gentamicin prescription in an anaesthesia-ICU. A Cmax ≥30 mg L remains difficult to achieve, but a Cmax ≥16 mg L could be considered relevant for community infections and would be more attainable. A corrective formula could be used to adjust the dosage.
文献中已描述了麻醉重症监护病房（ICU）中脓毒症和感染性休克情况下大量庆大霉素剂量不足的病例。开展了一项临床实践调查，旨在使该病房庆大霉素的使用合理化。次要目标是提出一个用于调整个体剂量的校正公式。
采用单中心调查来确定在麻醉ICU中脓毒症/感染性休克最初几小时内给予的庆大霉素初始剂量。初始回顾性阶段有助于关注处方方面的改进点。第二个前瞻性阶段能够评估实施变更后的益处。
回顾性阶段（2014 - 2015年）纳入了51例患者，前瞻性阶段（2016 - 2017年）纳入了28例患者。在这两个研究阶段之间，不符合指南的处方显著减少（即肺部感染从70.5%降至18%，p<0.001），且平均±标准差给药剂量从7.3±1.2 mg/kg增加到9.5±1.5 mg/kg（p<0.001）。然而，Cmax（血浆峰浓度）≥30 mg/L的比例和平均Cmax没有显著变化。在Cmax、体重指数、血细胞比容和肌酐之间发现了显著关联（p<0.05），从而能够提出一个校正公式。
本研究使麻醉ICU中庆大霉素的处方得到了改进。Cmax≥30 mg/L仍然难以实现，但Cmax≥16 mg/L可被认为与社区感染相关且更易于达到。一个校正公式可用于调整剂量。
