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Continuous infusion of beta-lactam antibiotics in pediatric intensive care unit: A monocenter before/after
Gwendoline Ragonnet1, Romain Guilhaumou2, Omar Hanafia1
1Pharmacie à Usage Intérieur Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France.
Insights
Protocolizing beta-lactam continuous infusion (CI) significantly improved target concentration achievement in pediatric intensive care units (PICU). This approach also reduced costs and nursing time.
Area of Science:
- Pediatric Intensive Care Medicine
- Pharmacokinetics and Pharmacodynamics
- Antibiotic Therapy Optimization
Background:
- Beta-lactam continuous infusion (CI) is standard for adults but less studied in pediatric intensive care units (PICU).
- Achieving target drug concentrations is crucial for effective antibiotic treatment in critically ill children.
Purpose of the Study:
- To evaluate the impact of protocolizing beta-lactam CI on achieving target concentrations in PICU patients.
- To assess the cost-effectiveness and time-saving benefits of this protocol.
Main Methods:
- A single-center retrospective study compared two periods: intermittent infusion (P1) versus protocolized CI (P2).
- Therapeutic drug monitoring (TDM) was used to assess drug concentrations.
- The primary endpoint was achieving fT>4× Minimum Inhibitory Concentration=100%.
Main Results:
- Target concentration achievement was significantly higher in the CI group (73.7% vs. 29.1%, p<0.001).
- CI was associated with lower C-reactive protein levels, reduced costs, and decreased nursing preparation time.
- Multivariable analysis identified CI, body surface area, and albumin as positive predictors of target achievement.
Conclusions:
- Protocolized beta-lactam CI enhances target concentration achievement in PICU.
- This strategy offers potential cost savings and reduces nursing workload.
- Implementation of beta-lactam CI protocols is recommended for PICU settings.
Context:
Beta-lactam continuous infusion (CI) is currently recommended in adult intensive care units to achieve target concentrations. In pediatric intensive care (PICU), few studies suggest the value of Beta-lactam CI to achieve target concentration. Our objective was to analyze the impact of Beta-lactam CI protocolization on the achievement of target concentration in PICU patients.
Material And Methods:
We conducted a single-center retrospective study in patients with beta-lactam treatment for more than 2 days and at least one sample for therapeutic drug monitoring (TDM). From January 2018 to February 2022 (period 1, P1), BL were administered as an intermittent infusion with TDM upon request. From February to September 2022 (period 2, P2), Beta-lactam CI with TDM at day one was protocolized. The primary endpoint concerned achieving fT>4× Minimum Inhibitory Concentration = 100%.
Results:
In P1, 214 assays involved 103 patients; in P2, 199 assays involved 72 patients. Target concentration achievement was more frequent in P2 (P2 = 73.7% vs. P1 = 29.1%; p < 0.001). At day 5/6 after Beta-lactam initiation, c-reactive protein concentrations were P1 = 84.9 ± 79.2 mg/L; P2 = 53.7±49.8 mg/L (p < 0.05). In the multivariable logistic regression model: P2, BSA, and albumin were positively associated with target achievement; urea, and male sex were negatively associated with target achievement. The daily average cost of beta-lactam vial consumption per child was: P1 = 5.04 ± 2.6 ; vs. P2 = 3.21 ± 2.7 ; (p-value < 0.001). The daily average reconstitution time of Beta-lactam syringes per child was: P1 = 23.5 ± 8.7 min, P2 = 13.9 ± 9.2 min (p-value < 0.001).
Conclusion:
Protocolization of Beta-lactam continuous infusion was associated with more frequent target concentration achievements in PICU. This implementation could be cost-effective and nurse time-saving.
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