Beta-Lactams Dosing In Pneumonia in ICU in Patients Treated by Continuous Renal Replacement Therapy: the BLIPIC Study

Inclusion Criteria

• •Aged ≥ 18 years
• •Receiving intraveinous beta-lactam : amoxicillin, amoxicillin-clavulanic acid, piperacillin-tazobactam, cefotaxime, ceftazidime, cefepime, meropenem, imipenem
• •With AKI defined as any of the following, and treated with Multifiltrate Ci-Ca CVVHD 1000® kit with a dialysis dose of 25 ml/kg/h :
• •* Increase in creatininemia ≥ 0.3 mg/dl (≥ 26.5 µmol/l) within 48 hours
• •* Increase in creatininemia ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days
• •* Urine volume \< 0.5 ml/kg/h for 6 hours
• •Hospitalized in ICU
• •Presence of a catheter to facilitate sample collection
• •With pneumonia defined as any of the following :
• •* Chest X-ray pneumonia : opacities, new or progressive infiltrates
• •* AND at least one of the following : hyperthermia \> 38°C or hypothermia \< 36°C with no other explanation ; leukopenia \< 4 G/L ou leukocytosis \> 12G/L
• •* AND at least one of the following : new onset purulent sputum or change in sputum character, new onset or worsening cough or dyspnea or tachypnea, rales or bronchial breathing, lower oxygen saturation/hypoxemia or increase of oxygen needs or respiratory assistance
• •Treated within 24 hours by citrate hemodialysis AND beta-lactam respecting dose and administration conditions of the study :
• •* Amoxicillin : loading dose followed immediately by 2g by extended infusion for 4 hours every 8 hours
• •* Amoxicillin-clavulanic acid : 2g every 8 hours by intermittent bolus
• •* Piperacillin-tazobactam: loading dose followed immediately by 4g/0.5g by continuous infusion every 8 hours (\< 80 kg) ou 6 hours (\> 80 kg)
• •* Cefotaxime: loading dose followed immediately by 2g by continuous infusion every 8 hours Ceftazidime : loading dose followed immediately by 2g by continuous infusion every 8 hours
• •* Cefepime: loading dose followed immediately by 2g by continuous infusion every 8 hours
• •* Meropenem : loading dose followed immediately by 2g (\> 60 kg) ou 1,33g (\< 60 kg) by extended infusion for 4 hours every 8 hours
• •* Imipenem : loading dose followed immediately by 750 mg (\< 80 kg) ou 1g (\> 80 kg) by extended infusion for 4 hours every 6 hours In case of extrem weight, dose will be on investigator's discretion but administration conditions have be to respected.
• •No objection has been obtained from the patient or their legally authorised representative