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Overweight patients are susceptible to develop acute complications when they are admitted in an Intensive Care Unit (ICU). Severe infection can be associated with cardiovascular failure ('shock") and is associated with 35-50% mortality. One of the key issue to cure infection is to administer antibiotics. However, under dosing antibiotic is one of the main reason that explain treatment failure. There are very few data concerning particularities of antibiotic dosing in critically ill, overweight, patients. The aim of the present study is to describe the pharmacokinetic of two main antibiotics (doripenem and piperacillin/Tazobactam) in both overweight and non overweight critically ill patients presenting a septic shock. The investigators hypothesis is that usual dose for those antibiotic may be accurate in non overweight patients but is not in overweight patients.
N=52 patients divided in 4*13 patients (13 per antibiotic and per group, overweight or non overweight).
Overweight is defined by a weight over 120kg. Antibiotic chosen by the intensivist in charge of the case. Doripenem 1g/8h with a 4h IV infusion whatever the patient's weight. Piperacillin/Tazobactam 4g IV (1h) and then 16g/24h IV continuously whatever the patient's weight.
Piperacillin/Tazobactam plasma dosage: after the first dose and then every 12h. Doripenem plasma dosage: after the first dose and then twice a day, at peak and residual value.
Usual plasma and urine samples for urea, creatinine, electrolytes, platelets and bilirubin each 24h.
Microbiology: bacterial identification and MIC measurement with E-test
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No overweight patient | Experimental | Patient with weight less than or equal to 120kg |
|
| Overweight patients | Experimental | Patient with weight more than 120kg |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Doripenem or Piperacillin/Tazobactam | Drug | This arm is composed of 26 no overweight patients, Antibiotic (Doripenem or Piperacillin/Tazobactam) is chosen by the intensivist in charge of the case:
|
| Measure | Description | Time Frame |
|---|---|---|
| Time over MIC (calculated with the E-test) in overweight and non overweight critically ill patients | up to Day 8 |
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Inclusion Criteria:
General:
Specific to overweight patients: Weight > 120kg
Specific to no overweight patients: Weight less than or equal to 120kg
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Boris BJ JUNG, MD | Saint Eloi Hospital - Montpellier University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Saint Eloi Intensive Care Unit - Montpellier University Hospital | Montpellier | 34295 | France |
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| ID | Term |
|---|---|
| D012772 | Shock, Septic |
| D050177 | Overweight |
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D018805 | Sepsis |
| D007239 | Infections |
| D018746 | Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
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| ID | Term |
|---|---|
| D000077726 | Doripenem |
| D010878 | Piperacillin |
| D000078142 | Tazobactam |
| ID | Term |
|---|---|
| D015780 | Carbapenems |
| D047090 | beta-Lactams |
| D007769 | Lactams |
| D000577 | Amides |
| D009930 |
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|
|
| Doripenem or Piperacillin/Tazobactam | Drug | This arm is composed of 26 overweight patients, Antibiotic (Doripenem or Piperacillin/Tazobactam) is chosen by the intensivist in charge of the case:
|
|
|
| D010335 |
| Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012769 | Shock |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D020969 | Disease Attributes |
| Organic Chemicals |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D000667 | Ampicillin |
| D010400 | Penicillin G |
| D010406 | Penicillins |
| D013457 | Sulfur Compounds |
| D010397 | Penicillanic Acid |
| D013450 | Sulfones |