Aminoglycoside Administration in Septic Patients with Impaired Renal Function Using Continuous Renal Replacement Therapy to Optimize Dosing and Minimize Toxicity

What this Trial Is About

Sepsis and septic shock are serious conditions that often lead to death or severe illness in intensive care units (ICUs). This research focuses on infections caused by multidrug-resistant gram-negative bacteria, which are common in these patients. Aminoglycosides are antibiotics known to be effective against these bacteria, but their use can be limited by kidney-related side effects, especially in patients with existing kidney problems. The study aims to see if using a special blood filtering technique can help remove the antibiotic after it reaches a strong level in the blood, reducing potential harm while maintaining its effectiveness. The study compares three groups of ICU patients who have sepsis or septic shock and impaired kidney function. One group receives continuous renal replacement therapy (CRRT) alongside aminoglycoside antibiotics, another starts antibiotics first and later begins CRRT if needed, and the third group receives antibiotics without CRRT. Aminoglycosides like amikacin, gentamicin, and tobramycin are given in specific doses, and CRRT is used to clear the drug from the bloodstream to allow safer and potentially more frequent dosing. CRRT is applied using filters and anticoagulants, with treatment schedules varying among the groups. Participants will be monitored closely for drug levels in their blood, kidney function, infection markers, and overall health using scores like SOFA over several days. Blood cultures and kidney clearance tests are done before and during treatment. The study tracks several outcomes including how many doses of antibiotic can be given, drug concentration achievement, clinical response during 11 days, and longer-term effects such as mortality, kidney health, inflammation markers, ICU stay length, and survival up to six months.

Aminoglycoside Administration in Septic Patients