Evaluation of Pharmacokinetic / Pharmacodynamic Data and Interest Individualized Therapeutic Drug Monitoring Glycopeptides and β-lactam-aminoglycoside ICU

Primary / secondary objective

Investigators propose to conduct a study with the goal:

• Evaluate the rate of patients for whom efficacy endpoint PK / PD Cmax / MIC ≥ 8-10 is reached at the first dose of the usual doses.
• Compare the 30-day mortality among patients with subclinical a first rate versus those who have reached the desired peak

• Evaluate the rate of patients for whom PK / PD efficiency target for related antibiotics is reached:

  • Serum residual> 4X MIC for the β-lactam rate and continuous function of β-lactam and the germ.
  • Serum between 25 and 35 mg / L vancomycin continuously.
• Assess the factors associated with obtaining a rate of aminoglycoside subtherapeutic peak in a population of critically ill patients.
• Assess the residual to 12h after injection to an anticipation of residual dosed at 24.

Methodology :

• Type Of study:
• Prospective, single-center type of professional practice evaluation
• Expected duration of the study six months
• Objective inclusion: 50 to 100 patients. Computing the number of patients to be included was done via the BioStaTGV software.
• Description Of the study (according to recommendations):
• Admission of patients in intensive care unit
• Levy peak aminoglycoside 30min after the end of the 30 minutes of infusion the first administration
• Collection of residual aminoglycoside to + 12h and between 23h-30 and 24 hours after injection.
• Extraction of the residual H + 24h, 30 min before injection to the β-lactam associated administered discontinuously or without time constraints if administration batchwise to the β-lactam and vancomycin.
• Routing unsettled and not frozen tubes in \<2 hours of collection
• Reception and registration levy of the laboratory assay of anti-infective under his usual care as recommended service
• Determination of aminoglycoside and vancomycin immunoturbidimetric method (Indiko PLUS)
• Β-lactam assay by LC-MS
• Rendering the usual result (result server consultation for partial and report PDF available on the patient's medical record DXcare).
• Director-post of MIC of aminoglycoside and β-lactam vis-à-vis the offending germ for each bacterial strain isolated and documenting infection
• Destruction Levies: levies will not be retained after being used for the study. They will be destroyed in accordance with the rules of good practice research laboratories.

Data Monitoring and support:

Patient data will be collected on a computer CRF including clinical, biological and microbiological data of patients via the patient's medical record on DXcare: demographics, weight, height, BMI, hydration status, kidney function, liver function, shock, chronic heart failure, malnutrition, hypoalbuminemia burned, cirrhosis, chronic rheumatic disease, other antecedents, pregnancy, reason for hospitalization, etiology of sepsis motivating the introduction of aminoglycosides, β-lactam or glycopeptide and also other associated treatments. The data collected will help identify risk factors associated with a sub-therapeutic dosing aminoglycosides, β-lactam or glycopeptide.