Impact of Imipenem With Amikacin Pharmacokinetic and Pharmacodynamic (IMPACT)
Ventilator Associated Pneumonia
About this trial
This is an interventional treatment trial for Ventilator Associated Pneumonia focused on measuring Intensive care unit, Ventilator associated pneumonia, Gram negative bacilli infection, Empirical antibiotic therapy, Pharmacokinetic / pharmacodynamic, Imipenem, Amikacin, Gram negative bacilli
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18 years
- Mechanical ventilation for more than 48 hours
- Clinical suspicion of VAP defined by a new persistent radiological infiltrate and one of the following signs: purulent tracheal aspirations, or temperature of 38°3 or higher, or leucocyte count > 10000/ml
- Risk of multi resistant bacteria defined as follows: at least 6 days of mechanical ventilation or antibiotic treatment in the 15 previous days
- Distal pulmonary secretion sample obtained beforehand for microbiological diagnosis by bronchoalveolar lavage via bronchoscopy or blinded protected telescoping catheter via bronchoscopy or blindly
- Presence of GNB on direct examination of the distal pulmonary secretion sample
- Realization of a preliminary medical examination. 8- Written inform consent from the patient or relatives. The consent may be obtained after the enrollment if the patient is not able to give consent and if there is no relatives
Exclusion Criteria:
- Time between distal pulmonary secretion sample taking and the 1st administration of imipenem exceeding 24 hours
- Pregnancy
- Severely impaired renal function (creatinine clearance lower than 10 mL/mn or renal replacement therapy)
- Allergy to imipenem or amikacin
- Treatment in progress with imipenem or amikacin
- Death expected within 48 hours following diagnosis of VAP
- Myasthenia
- Simultaneous administration of others aminoglycosides
- Association with intravenous polymyxin or botulinum toxin
Sites / Locations
- Victor Dupouy Hospital
Arms of the Study
Arm 1
Experimental
1:Imipenem/Amikacin
patients will receive as empirical therapy for VAP imipenem associated with amikacin.After primary outcome measure, antibiotic therapy will be left at the discretion of the physician in charge of the patient. Imipenem: recommended usual dosage for VAP treatment, IV (in the vein), every 8 hours Amikacin: recommended usual dosage for VAP treatment (20mg/kg), IV (in the vein), single dose (at H0) for the 48 first hours of treatment