KẾT QUẢ ĐIỀU TRỊ VIÊM PHỔI VÀ NHIỄM KHUẨN HUYẾT DO KLEBSIELLA PNEUMONIAE SỬ DỤNG AMIKACIN CÓ GIÁM SÁT NỒNG ĐỘ TRONG MÁU

Abstract

Objective: Evaluate the results of treatment pneumonia and bloodstream infections due to Klebsiella pneumoniae using amikacin with therapeutic drug monitoring and describe nephrotoxicity. Subjects and methods: An interventional clinical study on patients with pneumonia and bloodstream infections due to K.pneumoniae in the ICU. The dose of amikacin was 30 mg/kg adjusted body weight (ABW). The goal of therapeutic drug monitoring (TDM) are C_peak of 45 – 60 mg/L, ratio C_peak/MIC 8-10, C_trough < 2mg/L. We recorded the clinical response and development of acute kidney injury (AKI). Results: 42 patients were admitted to the study. The mean age of patients was 56.1 ±19 years. Male 76.2%. APACHE II score on admission ICU was 16, SOFA score on admission ICU was 8[4,5], Chalson score was 1[2]. The rate of septic shock at the time of amikacin administration was 35.7%. Ventilator patients 85.7%. Pneumonia infection 83.3%. MIC of K.pneumoniae with amikacin was 4[2-5], MIC≤8 rate was 92.9%. The overall clinical complete response rate of the treatment course was 57.1%. The rate of clinical complete response on day 5 more than day 3, day 7 more than day 5 (p<0.05). The clinical complete response group and the non-clinical complete response group had differences on APACHE II score, SOFA score on admission, SOFA score at the beginning of treatment, Hct at the beginning of treatment and rate of mechanical ventilation (p<0.05) and no differences in C_peak/MIC, MIC (p>0.05). In patients with C_trough <2mg/L, the rate of occurrence of AKI percentage was 38.1%, at risk stage (87.5%) and time of appearance 6.1±3.6 days. Conclusions: The rate of complete clinical response when treating pneumonia and bacteremia infections due to K.pneumoniae using amikacin dose of 30mg/kg ABW was 57.1%. Patients with high APACHE II score, high SOFA score on admission, high SOFA score at the beginning of treatment, requiring mechanical ventilation have a poorer clinical response. The rate of acute kidney injury was 38.1%.