[Monitoring vancomycin in an intensive care unit: A retrospective survey on 66 patients]. / Monitorage de la vancomycine en réanimation : étude rétrospective de 66 patients.

OBJECTIVES: The study objectives were to check whether recommended vancomycin doses were related to pharmacological objectives for intensive care patients: steady-state plasma concentration (SSc) and ratio SSc/MIC (Minimal Inhibiting Concentration). The authors tried to identify variability factors for vancomycin plasmatic concentrations at peak. PATIENTS AND METHODS: This monocentric, observational, and retrospective survey was performed on 66 intensive care patients treated by antibiotics including vancomycin, alone or in combination, as a curative treatment for a severe infection with Gram-positive bacteria. Vancomycin was dosed at 15mg/kg during the first hour, then 40 to 60mg/kg per 24hour. Vancomycin SSc and bacteria MIC were recorded. The SSc/MIC ratio was determined and was considered efficient when superior to 8. RESULTS: Forty-two percent of vancomycin SSc were within the effectiveness rate. Twenty-three percent of SSc/MIC ratios were superior to 8. The rate of clinical recovery was 71 %. The length of antibiotherapy was identified as positively interacting with biological effectiveness, unlike severe sepsis, a factor of negative interaction on vancomycin SSc in this study. CONCLUSION: Less than half of the SSc and less than a quarter of the SSc/MIC ratios were at effective rates in our study. Therefore, adequacy between dosage, administration, and monitoring should be reviewed.

[Monitoring aminoglycosides in an Intensive Care Unit]. / Monitorage des aminosides en réanimation.

OBJECTIVES: This monocentric, observational and retrospective survey was performed to check the appropriateness between aminoglycoside prescriptions and inhibitor quotient to be reached, in Intensive Care Unit (ICU) patients. We identified variability factors for aminoglycoside plasmatic concentrations at peak such as standardized index of gravity (IGS2 scale), age, sex, weight, and severity of sepsis. PATIENTS AND METHOD: Eighty-seven ICU patients received an antibiotic combination mandatorily including an aminoglycoside (amikacin or gentamicin) as curative treatment for a severe infection. Prescribed dosages were 15mg/kg for amikacin and 5mg/kg for gentamicin. The maximal concentration (Cmax) and minimal inhibiting concentration (MIC) of involved bacteria were recorded. The aminoglycoside ratio Cmax/MIC, called inhibitor quotient, was determined. The inhibitor quotient was considered efficient when superior to 10. The Cmax for aminoglycoside first peak was also compared with the theoretical Cmax to be reached. RESULTS: In the aminoglycoside Cmax, 50.3% were efficient (59.6% for amikacin Cmax and 38.9% for gentamicin Cmax). In 46% of the cases, the inhibitor quotient was efficient; 12.6% of Cmax reached the theoretical Cmax. Factors identified as negatively interacting with biological efficiency were: Gram-positive bacteria or anaerobic bacteria infections and planned surgery. CONCLUSION: In the inhibitor quotients, 49.7% were at inefficient rates, even when the recommended aminoglycoside dosage for was given. Therefore, dose and administration should be updated.