Empirical Antibiotic Therapy for Gram-Negative Bacilli Ventilator-Associated Pneumonia: Observational Study and Pharmacodynamic Assessment

Background: Strong evidence suggests a correlation between pharmacodynamics (PD) index and antibiotic efficacy while dose adjustment should be considered in critically ill patients due to modified pharmacokinetic (PK) parameters and/or higher minimum inhibitory concentrations (MICs). This study aimed to assess pharmacodynamic (PD) target attainment considering both antibiotics serum concentrations and measured MICs in these patients. Method: A multicentric prospective open-label trial conducted in 11 French ICUs involved patients with Gram-negative bacilli (GNB) ventilator-associated pneumonia (VAP) confirmed by quantitative cultures. Results: We included 117 patients. Causative GNBs were P. aeruginosa (40%), Enterobacter spp. (23%), E. coli (20%), and Klebsiella spp. (16%). Hence, 117 (100%) patients received beta-lactams, 65 (58%) aminoglycosides, and two (1.5%) fluoroquinolones. For beta-lactams, 83% of the patients achieved a C-min/MIC > 1 and 70% had a C-min/MIC > 4. In the case of high creatinine clearance (CrCL > 100 mL/min/1.73 m(2)), 70.4% of the patients achieved a C-min/MIC ratio > 1 versus 91% otherwise (p = 0.041), and 52% achieved a C-min/MIC ratio > 4 versus 81% (p = 0.018). For aminoglycosides, 94% of the patients had a C-max/MIC ratio > 8. Neither beta-lactams nor aminoglycosides PK/PD parameters were associated clinical outcomes, but our data suggest a correlation between beta-lactams C-min/MIC and microbiological success. Conclusion: In our ICU patients treated for GNB VAP, using recommended antibiotic dosage led in most cases to PK/PD targets attainment for aminoglycosides and beta-lactams. High creatinine clearance should encourage clinicians to focus on PK/PD issues.