Turkish Journal of Anaesthesiology & Reanimation
ORIGINAL ARTICLE

Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation

1.

Department of Anesthesiology and Intensive care medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

2.

Statistical Unit, Desgenettes Military Teaching Hospital, Lyon, France

3.

Department of Microbiology, Desgenettes Military Teaching Hospital, Lyon, France

Turk J Anaesthesiol Reanim 2020; 48: 399-405
DOI: 10.5152/TJAR.2019.57255
Read: 89 Downloads: 41 Published: 14 January 2020

Objective: 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.
 

Methods: 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.

 

Results: 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−1 to 9.5±1.5 mg kg−1 (p<0.001). Nevertheless, the proportion of Cmax (peak plasma concentration) ≥30 mg L-1 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.

 

Conclusion: The present study allowed improvement in gentamicin prescription in an anaesthesia-ICU. A Cmax ≥30 mg L−1 remains difficult to achieve, but a Cmax ≥16 mg L−1 could be considered relevant for community infections and would be more attainable. A corrective formula could be used to adjust the dosage.

 

Cite this article as: Pernod C, Lamblin A, Cividjian A, Gerome P, Pierre-François W. Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation. Turk J Anaesthesiol Reanim 2020; 48(5): 399-405.

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