| Title: |
Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study |
| Authors: |
Dupont, V.; Mourvillier, B.; Barbe, C.; Legros, V.; Jozwiak, M.; Merdji, H.; Dupuis, C.; Winiszewski, H.; Marchalot, A.; Lacave, G.; Neuville, M.; Sagnier, A.; Barbier, F.; Thivilier, C.; Ruiz, S.; Smonig, R.; Rosman, J.; Argaud, L.; Grangé, S.; Sarton, B.; Chillet, P.; Voiriot, G.; Kanagaratnam, L.; Djerada, Z. |
| Contributors: |
Hôpital universitaire Robert Debré Reims (CHU Reims); Université de Reims Champagne-Ardenne (URCA); CHU Nice Cimiez; Hôpital Cimiez Nice (CHU); Centre Hospitalier Universitaire Strasbourg (CHU Strasbourg); Hôpitaux Universitaires de Strasbourg (HUS); CHU Clermont-Ferrand; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon); Centre hospitalier de Dieppe; Centre Hospitalier de Versailles André Mignot (CHV); Hôpital Foch Suresnes; CHU Amiens-Picardie; Centre Hospitalier Regional d'Orléans (CHRO); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy); Centre Hospitalier Universitaire de Toulouse (CHU Toulouse); Centre Hospitalier de Lorient (CH Lorient); Groupe Hospitalier Bretagne Sud (GHBS); Centre hospitalier de Sedan (CHI Nord Ardennes - site de Sedan); Centre Hospitalier Lyon Sud CHU - HCL (CHLS); Hospices Civils de Lyon (HCL); CHU Rouen; Normandie Université (NU); Toulouse NeuroImaging Center (ToNIC); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Toulouse (EPE UT); Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Toulouse Mind & Brain Institut (TMBI); Université Toulouse - Jean Jaurès (UT2J); Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Université de Toulouse (EPE UT); Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Université Toulouse - Jean Jaurès (UT2J); Communauté d'universités et établissements de Toulouse (Comue de Toulouse)-Université de Toulouse (EPE UT); Communauté d'universités et établissements de Toulouse (Comue de Toulouse); Hospital Chalons en Champagne; CHU Tenon AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Université Paris-Est (UPE); Centre de Recherche Saint-Antoine (CRSA); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU) |
| Source: |
ISSN: 2110-5820 ; Annals of Intensive Care ; https://inserm.hal.science/inserm-05190301 ; Annals of Intensive Care, 2025, 15 (1), pp.42. ⟨10.1186/s13613-025-01461-z⟩. |
| Publisher Information: |
CCSD; SpringerOpen |
| Publication Year: |
2025 |
| Collection: |
Université Toulouse III - Paul Sabatier: HAL-UPS |
| Subject Terms: |
mikacin; Aminoglycoside; Intensive care unit; Pharmacokinetic; Renal replacement therapy; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; BACKGROUND: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in intensive care units (ICUs), yet optimal amikacin dosing in this context remains poorly understood. METHODS: We conducted a prospective observational study across 18 French hospitals from April 2020 to January 2022. Adult ICU patients (aged \textgreater 18 years) receiving their first amikacin dose while on RRT were included. Data on demographics, RRT modalities, amikacin dosing, and therapeutic drug monitoring were collected. Using a pharmacokinetic modeling approach, we evaluated various amikacin regimens and simulated target attainment probabilities across different minimum inhibitory concentrations (MICs). RESULTS: A total of 111 patients were included, with approximately two-thirds receiving continuous RRT. The median amikacin dose was 27 (25-30) mg/kg. Amikacin peak (Cmax) and trough concentrations were monitored in 53 (47.8%) and 76 (68.5%) patients, respectively. Continuous RRT and a history of chronic kidney disease reduced dialytic clearance. For a MIC ≤ 4 mg/L, a 15 mg/kg amikacin dose achieved Cmax/MIC and AUC/MIC targets in ≥ 90% of patients on intermittent dialysis, while 20 mg/kg was required for those on continuous dialysis. For a MIC = 8 mg/L, a 30 mg/kg dose was necessary to achieve Cmax/MIC ≥ 8. CONCLUSIONS: Our findings highlight suboptimal adherence to amikacin monitoring guidelines in ICU patients on RRT. Using pharmacokinetic modeling, we identified amikacin dosing recommendations ranging from 15 to 35 mg/kg to optimize efficacy and minimize risks, depending on MIC and dialysis modality. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40133728; PUBMED: 40133728; PUBMEDCENTRAL: PMC11937451 |
| DOI: |
10.1186/s13613-025-01461-z |
| Availability: |
https://inserm.hal.science/inserm-05190301; https://doi.org/10.1186/s13613-025-01461-z |
| Accession Number: |
edsbas.DF042173 |
| Database: |
BASE |