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Master Thesis

L’augmentation des posologies en β-lactamines permet-elle de réduire le taux d’échec thérapeutique chez les patients en hyperclairance rénale traités pour une pneumopathie associée aux soins ?

Abstract : Background: augmented renal clearance (ARC) is recognized as a leading cause of β-lactam subexposure when conventional dosing regimens are used. The main objective was to compare the clinical outcome of ARC patients treated by conventional or increased β-Lactams dosing regimens for a first episode of hospital or ventilator-acquired pneumonia (HAP-VAP). Methods: in this single-center, retrospective study, every ARC patient treated by β-lactam for a first episode of HAP-VAP was included during two 15-month periods, before (Control period) and after (Treatment period) the modification of a local antibiotic therapy protocol. ARC was defined by a 24-hr measured creatinine clearance ≥ 150 ml/min. The primary endpoint was defined as a therapeutic failure of the antimicrobial therapy or a HAP-VAP recurrence within 28 days. Propensity score analysis was performed to assess the primary outcome while controlling for relevant covariates. Results: during the study period, 177 patients were included (control period, N = 88; treatment period, N = 89). Therapeutic failure or HAP-VAP relapse were significantly lower in the treatment period (10 vs. 23%, p = 0.019). The propensity adjusted hazard ratio in the patients treated with the increased dosing regimens protocol was 0.47 (95%CI: 0.25 – 0.98). No antibiotic side effect was reported during the treatment period. Conclusions: higher than licensed dosing regimens of β-Lactams may be safe and effective in reducing the rate of therapeutic failure and HAP-VAP recurrence in critically ill patients with severe ARC.
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Grégoire Chadefaux. L’augmentation des posologies en β-lactamines permet-elle de réduire le taux d’échec thérapeutique chez les patients en hyperclairance rénale traités pour une pneumopathie associée aux soins ?. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02433710⟩

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