Nicolas Boussekey

Centre Hospitalier de Tourcoing

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O. Leroy

Aix-Marseille Université

Hugues Georges

Centre Hospitalier de Tourcoing

Arnaud Chiche

Centre Hospitalier de Tourcoing

Agnès Meybeck

Centre Hospitalier de Tourcoing

Patrick Devos

Centre Hospitalier Universitaire de Lille

S. Alfandari

Centre Hospitalier de Tourcoing

Pierre-Yves Delannoy

Centre Hospitalier de Tourcoing

Benoît Guéry

University of Lausanne

Pierre Patoz

Centre Hospitalier de Tourcoing

Damien Thellier

Centre Hospitalier de Tourcoing

Cooperative Institutions

Centre Hospitalier de Tourcoing

Inserm

Assistance Publique – Hôpitaux de Paris

Universitat de Barcelona

Université de Lille

Hospital Universitari Joan XXIII de Tarragona

Institut d'Investigació Sanitària Pere Virgili

Université Paris Cité

Centre Hospitalier Universitaire de Lille

Hospital Clínic de Barcelona

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Continuous Infusion of High Doses of Cefepime in Intensive Care Unit: Assessment of Steady-State Plasma Level and Incidence on Neurotoxicity

Antibiotics (2022)

Vanessa Jean-Michel Corentin Homey Patrick Devos Pierre-Yves Delannoy Nicolas Boussekey

Continuous infusion (CI) with high doses of cefepime is recommended in the empirical antimicrobial regimen of critically ill patients with suspected Gram-negative sepsis. This study aimed to determine factors associated with cefepime overdosing and the incidence of cefepime-induced neurotoxicity (CIN) in these patients. We performed a retrospective study including all patients receiving cefepime treatment between January 2019 and May 2022. The plasma level of cefepime defining overdosing was over 35 mg/L. Neurotoxicity was defined according to strict criteria and correlated with concomitant steady-state concentration of cefepime. Seventy-eight courses of cefepime treatment were analyzed. The mean cefepime plasma level at steady state was 59.8 ± 29.3 mg/L, and overdosing occurred in 80% of patients. Renal failure and a daily dose > 5 g were independently associated with overdosing. CIN was present in 30% of patients. In multivariate analysis, factors associated with CIN were chronic renal failure and a cefepime plasma concentration ≥ 60 mg/L. CIN was not associated with mortality. Overdosing is frequent in patients receiving high doses of cefepime by CI. Steady-state levels are higher than targeted therapeutic pharmacokinetic/pharmacodynamic objectives. The risk of CIN is important when the plasma concentration is ≥60 mg/L.

Cefepime

Neurotoxicity

Plasma levels

10.3390/antibiotics12010069

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Citations (4)

Adult community-acquired bacterial meningitis requiring ICU admission: epidemiological data, prognosis factors and adherence to IDSA guidelines

European Journal of Clinical Microbiology & Infectious Diseases (2009)

Hugues Georges Arnaud Chiche S. Alfandari Patrick Devos Nicolas Boussekey

Medical microbiology

Univariate analysis

Empiric therapy

10.1007/s10096-009-0782-9

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Citations (19)

Impact of combination therapy and early de-escalation on outcome of ventilator-associated pneumonia caused by Pseudomonas aeruginosa

Infectious Diseases (2017)

Laurène Deconinck Agnès Meybeck Pierre Patoz Nicolas Van Grunderbeeck Nicolas Boussekey

Pseudomonas aeruginosa is a common cause of ventilator-associated pneumonia (VAP). Guidelines recommend dual coverage of P. aeruginosa, but the beneficial effect of combination therapy is controversial. We described antibiotic prescriptions and evaluated the clinical impact of initial combination antibiotic therapy and de-escalation strategy in patients with VAP caused by P. aeruginosa.Between 1994 and 2014, all 100 patients with VAP caused by P. aeruginosa in our intensive care unit (ICU) were included in a retrospective cohort study to evaluate the prognostic impact of initial combination antibiotic therapy.Eighty-five patients received initial combination antibiotic therapy and 15 monotherapy. Nine patients received inadequate initial antibiotic therapy. De-escalation was performed in 42 patients. Thirty-nine patients died in the ICU. Factors independently associated with death were SAPS II score [SAPS II ≥40 versus <40: hazard ratio (HR) 2.49, 95% confidence interval (CI) 1.08-5.70, p = 0.03] and septic shock (HR = 4.80, 95% CI = 1.90-12.16, p < 0.01) at onset of VAP. Initial combination antibiotic therapy (HR = 1.97, 95% CI = 0.56-6.93, p = 0.29) and early de-escalation (HR = 0.59, 95% CI = 0.27-1.31, p = 0.19) had no impact on mortality. In multivariate analysis, the risk for inappropriate initial antibiotic therapy was higher in cases with multi-drug resistant P. aeruginosa [odd ratio (OR) = 7.11, 95% CI = 1.42-35.51, p = 0.02], but lower in cases with initial combination antibiotic therapy (OR = 0.12, 95% CI = 0.02-0.63, p = 0.01).In our cohort, combination therapy increased the likelihood of appropriate therapy but did not seem to impact on mortality.

Ventilator-associated Pneumonia

Combination therapy

De-escalation

10.1080/23744235.2016.1277035

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Citations (21)

Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine (2018)

Fernando G. Zampieri Pedro Póvoa Jorge I. Salluh Alejandro Rodríguez Sandrine Valade

Objective: To assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS). Materials and Methods: Post hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders. Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models. Results: The cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone. Conclusion: After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.

Respiratory tract

10.1177/0885066618772498

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Citations (14)

Survival in Critically Ill Patients with Acute Kidney Injury Treated with Early Hemodiafiltration

The International Journal of Artificial Organs (2012)

Nicolas Boussekey Benoît Capron Pierre-Yves Delannoy Patrick Devos S. Alfandari

Purpose Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients. Methods We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification. Results A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing >16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission <500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission >70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation <16 h and RRT initiation >16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group. Conclusions Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.

Rifle

Renal replacement therapy

SAPS II

10.1177/039139881203501202

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Citations (6)

CRP: A New Prognosis Marker in Community-Acquired Pneumonia?

The American Journal of Medicine (2008)

Nicolas Boussekey Nicolas Van Grunderbeeck O. Leroy

Procalcitonin

Pneumonia severity index

Etiology

10.1016/j.amjmed.2008.03.037

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Citations (2)

Validation of a Prediction Rule for Prognosis of Severe Community-Acquired Pneumonia~!2008-04-03~!2008-07-24~!2008-08-15~!

The Open Respiratory Medicine Journal (2008)

O. Leroy Dorota Mikolajczyk Patrick Devos Arnaud Chiche Nicolas Van Grunderbeeck

In a previous study, we developed a prognostic prediction rule, based on nine prognostic variables, capable to estimate and to adjust the mortality rate of patients admitted in intensive care unit for severe community-acquired pneumonia. A prospective multicenter study was undertaken to evaluate the performance of this rule. Five hundred eleven patients, over a 7-year period, were studied. The ICU mortality rate was 29.0%. In the 3 initial risk classes, we observed significantly increasing mortality rates (8.2% in class I, 22.8% in class II and 65.0% in class III) (p<0.001). Within each initial risk class, the adjustment risk score identified subclasses exhibiting significantly different mortality rates: 3.9% and 33.3% in class I; 3.1%, 12.9% and 63.3% in class II; and 55.8% and 82.5% in class III. Compared with mortality rates predicted by our previous study, only a few significant differences were observed. Our results demonstrate the performance and reproductibility of this prognostic prediction rule.

10.2174/1874306400802010067

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Citations (4)

Should highly active antiretroviral therapy be prescribed in critically ill HIV-infected patients during the ICU stay? A retrospective cohort study

AIDS Research and Therapy (2012)

Agnès Meybeck Lydie Lecomte M. Valette Nicolas Van Grunderbeeck Nicolas Boussekey

The impact of highly active antiretroviral therapy (HAART) in HIV-infected patients admitted to the intensive care unit (ICU) remains controversial. We evaluate impact of HAART prescription in HIV-infected patients admitted to the ICU of Tourcoing Hospital from January 2000 to December 2009.There were 91 admissions concerning 85 HIV-infected patients. Reasons for ICU admission were an AIDS-related diagnosis in 46 cases (51%). Fifty two patients (57%) were on HAART at the time of ICU admission, leading to 21 immunovirologic successes (23%). During the ICU stay, HAART was continued in 29 patients (32%), and started in 3 patients (3%). Only one patient experienced an adverse event related to HAART. Mortality rate in ICU and 6 months after ICU admission were respectively 19% and 27%. Kaplan-Meier estimates of the cumulative unajusted survival probability over 6 months were higher in patients treated with HAART during the ICU stay (Log rank: p = 0.04). No benefit of HAART in ICU was seen in the adjusted survival proportion at 6 months or during ICU stay. Prescription of HAART during ICU was associated with a trend to lower incidence of new AIDS-related events at 6 months (respectively 17% and 34% with and without HAART, p = 0.07), and with higher incidence of antiretroviral resistance after ICU stay (respectively 25% and 7% with and without HAART, p = 0.02).Our results suggest a lower death rate over 6 months in critically ill HIV-infected patients taking HAART during ICU stay. The optimal time to prescribe HAART in critically ill patients needs to be better defined.

10.1186/1742-6405-9-27

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Citations (30)

Impact of combination therapy with aminoglycosides on the outcome of ICU-acquired bacteraemias

European Journal of Clinical Microbiology & Infectious Diseases (2012)

P Delannoy Nicolas Boussekey Patrick Devos S. Alfandari Clément Turbelin

10.1007/s10096-012-1568-z

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Citations (23)

Concerns about renal safety of HES 130. Authors' response.

PubMed (2013)

Nicolas Boussekey O. Leroy

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