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A study to evaluate the first dose of gentamicin needed to achieve a peak plasma concentration of 30 mg/l in patients hospitalized for severe sepsis

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Abstract

Previous studies have shown that the high dose of gentamicin (8 mg/kg) rarely achieves the desired peak plasma concentration (Cmax) of ≥30 mg/l in patients with severe sepsis or septic shock. The aim of this study was to determine the first dose of gentamicin needed to achieve a Cmax ≥ 30 mg/l. We conducted a prospective observational cohort study in one intensive care unit. All consecutive patients hospitalized for severe sepsis or septic shock and treated with a first dose of gentamicin >6 mg/kg were evaluated. During the study period, 15 of the 57 patients (26.3 %) treated with gentamicin had a Cmax ≥ 30 mg/l. The median dose of gentamicin administered was 8.9 [7.8–9.9] mg/kg. Independent factors in the multivariate analysis associated with a Cmax ≥ 30 mg/l were higher body mass index (per kg/m2 increment) (OR: 1.173, 95%CI: 1.015–1.356, P = 0.03) and higher first dose of gentamicin (per mg/kg increment) (OR: 2.343, 95%CI: 1.346–4.08, P = 0.003). The optimal first dose to achieve a Cmax ≥ 30 mg/l was 11 mg/kg, with a specificity and a sensitivity of 100 % and 53.3 % respectively. These results suggest that a first dose of gentamicin >11 mg/kg is needed to achieve a Cmax ≥ 30 mg/l in most patients.

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Abbreviations

Cmax:

Peak plasma concentration

ICU:

Intensive care unit

IBW:

Ideal body weight

EUCAST:

European Committee on Antimicrobial Susceptibility Testing

MIC:

Minimal inhibiting concentration

SAPS:

Simplified acute physiology score

SOFA:

Sequential organ failure assessment

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Acknowledgments

Author Contributions

Drs Allou and Charifou had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design

Allou, Allyn, Galas, Valance, Martinet, and Vandroux.

Acquisition of data

Martinet, Valance, and Charifou.

Analysis and interpretation of data

Allou, Allyn, Martinet, Vandroux, and Valance.

Drafting of the manuscript

Allou, Galas, Martinet, Valance, and Allyn.

Critical revision of the manuscript for important intellectual content

Allou, Allyn, Vandroux, and Valance.

Statistical analysis

Allou, Allyn.

Obtained funding

Support was provided solely from institutional and/or departmental sources.

Administrative, technical, or material support

Allou, Allyn, Martinet, Charifou, and Galas.

Study supervision

Allou, Allyn, Charifou, and Valance.

Author information

Authors and Affiliations

  1. Réanimation polyvalente, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405, Saint Denis, France

    N. Allou, T. Galas, D. Valance, L. Corradi, O. Martinet, D. Vandroux & J. Allyn

  2. SAMU 974, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, 97405, Saint Denis, France

    Y. Charifou

  3. Département d’Anesthésie Réanimation, AP-HP, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France

    P. Augustin

Authors
  1. N. Allou
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  2. Y. Charifou
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  3. P. Augustin
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  4. T. Galas
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  5. D. Valance
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  6. L. Corradi
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  7. O. Martinet
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  8. D. Vandroux
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  9. J. Allyn
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Corresponding author

Correspondence to N. Allou.

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Funding

This work was internally funded

Conflict of Interest

The authors declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (This observational study was approved by the Ethics Committee of Félix Guyon University Hospital (R15015))

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Informed consent was obtained from all individual participants or their legally authorized representative included in the study.

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Cite this article

Allou, N., Charifou, Y., Augustin, P. et al. A study to evaluate the first dose of gentamicin needed to achieve a peak plasma concentration of 30 mg/l in patients hospitalized for severe sepsis. Eur J Clin Microbiol Infect Dis 35, 1187–1193 (2016). https://doi.org/10.1007/s10096-016-2652-6

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  • DOI: https://doi.org/10.1007/s10096-016-2652-6

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