Detectable Concentrations With Inhaled Tobramycin in Critically Ill Infants and Children Following Implementation of...

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacokinetics and Drug Monitoring
• Infectious Diseases

Background:

• A protocol for inhaled tobramycin was established for mechanically ventilated children to treat ventilator-associated tracheitis or pneumonia.
• The method involved vibrating mesh nebulization of tobramycin 300 mg every 12 hours.

Purpose of the Study:

• To determine the incidence of detectable tobramycin trough concentrations (>0.5 µg/mL).
• To compare clinical characteristics between patients with and without detectable concentrations.
• To identify patients who developed acute kidney injury (AKI) using KDIGO criteria.

Main Methods:

• A single-center retrospective study included critically ill children (<18 years) without cystic fibrosis receiving inhaled tobramycin.
• Data collected included demographics, tobramycin regimen, and renal function.
• Statistical analysis used SAS 9.4, with multivariable regression to identify factors for detectable concentrations and AKI.

Main Results:

• Forty-four patients (66 courses) were analyzed; 68% had detectable tobramycin concentrations.
• Twenty-point-five percent of patients developed AKI.
• No significant differences in demographics or clinical factors were found between groups with or without detectable concentrations or AKI.

Conclusions:

• The majority of inhaled tobramycin courses in this population achieved detectable concentrations.
• AKI was associated with approximately one-fourth of the treatment courses.
• Trough monitoring of inhaled tobramycin is recommended for all mechanically ventilated critically ill children.