Observational studyIntensive care medicine2014
Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen.
Observational study in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
47 citing papers in PubMed.
- Quantification and Explanation of the Variability of First-Dose Amikacin Concentrations in Critically Ill Patients Admitted to the Emergency Department: A Population Pharmacokinetic Analysis.European journal of drug metabolism and pharmacokinetics · 2021Trial
- Optimizing the initial amikacin dosage in adults.Antimicrobial agents and chemotherapy · 2015Trial
- Gentamicin pharmacokinetics in critically ill patients during treatment with continuous venovenous haemodiafiltration (CVVHDF).European journal of clinical pharmacology · 2015Trial
- Towards a holistic approach to pulmonary infections. Insights from the Sixth Annual Meeting of Spanish Experts 2024.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Review
- Amikacin use in critically ill patients requiring renal replacement therapy: the AMIDIAL-ICU study.Annals of intensive care · 2025Article
- A narrative review on antimicrobial dosing in adult critically ill patients on extracorporeal membrane oxygenation.Critical care (London, England) · 2024Review
- Risk Factors Associated with Antibiotic Exposure Variability in Critically Ill Patients: A Systematic Review.Antibiotics (Basel, Switzerland) · 2024Review
- Prediction of tissue exposures of polymyxin-B, amikacin and sulbactam using physiologically-based pharmacokinetic modeling.Frontiers in microbiology · 2024Article
- Aminoglycosides for the Treatment of Severe Infection Due to Resistant Gram-Negative Pathogens.Antibiotics (Basel, Switzerland) · 2023Review
- When and How to Use MIC in Clinical Practice?Antibiotics (Basel, Switzerland) · 2022Review
- Empirical Antibiotic Therapy for Gram-Negative Bacilli Ventilator-Associated Pneumonia: Observational Study and Pharmacodynamic Assessment.Antibiotics (Basel, Switzerland) · 2022Article
- Time-Kill Evaluation of Antibiotic Combinations Containing Ceftazidime-Avibactam against Extensively Drug-Resistant Pseudomonas aeruginosa and Their Potential Role against Ceftazidime-Avibactam-Resistant Isolates.Microbiology spectrum · 2021Article
- Assessment of the Effects of a High Amikacin Dose on Plasma Peak Concentration in Critically Ill Children.Paediatric drugs · 2021Observational
- Optimizing Antimicrobial Drug Dosing in Critically Ill Patients.Microorganisms · 2021Review
- Inhaled antibiotics during mechanical ventilation-why it will work.Annals of translational medicine · 2021Review
- An international survey on aminoglycoside practices in critically ill patients: the AMINO III study.Annals of intensive care · 2021Article
- Evaluation of Current Amikacin Dosing Recommendations and Development of an Interactive Nomogram: The Role of Albumin.Pharmaceutics · 2021Article
- Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation.Turkish journal of anaesthesiology and reanimation · 2020Article
- Aminoglycosides for the treatment of septic shock: a propensity-based study.Critical care (London, England) · 2020Article
- Amikacin pharmacokinetic/pharmacodynamic in intensive care unit: a prospective database.Annals of intensive care · 2020Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAmikacin requires pharmacodynamic targets of peak serum concentration (Cmax) of 8-10 times the minimal inhibitory concentration, corresponding to a target Cmax of 60-80 mg/L for the less susceptible bacteria. Even with new dosing regimens of 25 mg/kg, 30% of patients do not meet the pharmacodynamic target. We aimed to identify predictive factors for insufficient Cmax in a population of critically ill patients.
methodsProspective observational monocentric study of patients admitted to a general ICU and requiring a loading dose of amikacin. Amikacin was administered intravenously at the dose of 25 mg/kg of total body weight. Independent determinants of Cmax < 60 mg/L were identified by mixed model multivariate analysis.
resultsOver a 1-year period, 181 episodes in 146 patients (SAPS 2 = 51 [41-68]) were included. At inclusion, the SOFA score was 8 [6-12], 119 (66%) episodes required vasopressors, 150 (83%) mechanical ventilation, and 81 (45%) renal replacement therapy. The amikacin Cmax was 69 [54.9-84.4] mg/L. Overall, 60 (33%) episodes had a Cmax < 60 mg/L. The risk of Cmax < 60 mg/L associated with BMI < 25 kg/m(2) varied across quarters of inclusion. Independent risk factors for Cmax < 60 mg/L were a BMI < 25 kg/m(2) over the first quarter (odds ratio (OR) 15.95, 95% confidence interval (CI) [3.68-69.20], p < 0.001) and positive 24-h fluid balance (OR per 250-mL increment 1.06, 95% [CI 1.01-1.11], p = 0.018).
conclusionsDespite an amikacin dose of 25 mg/kg of total body weight, 33% of patients still had an amikacin Cmax < 60 mg/L. Positive 24-h fluid balance was identified as a predictive factor of Cmax < 60 mg/L. When total body weight is used, low BMI tended to be associated with amikacin underdosing. These results suggest the need for higher doses in patients with a positive 24-h fluid balance in order to reach adequate therapeutic targets.
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