Thực trạng sử dụng amikacin tại các khoa hồi sức, Bệnh viện Trung ương Quân đội 108: chế độ liều theo chức năng thận và tình trạng lọc máu

Abstract

Objective: A survey on the current usage of amikacin in the Intensive Care Units (ICUs) of the 108 Military Central Hospital, and a comparison of dosing regimens between non-dialysis and dialysis patients. Subject and method: A retrospective cross-sectional study was conducted on all adult in-patients who received intravenous amikacin in the ICUs from January 1, 2025, to June 30, 2025. Result: A total of 223 patients were included, with a median creatinine clearance (CrCl) of 53.3 mL/min. Amikacin was primarily prescribed for pneumonia (52.9%) and septic shock (45.3%). The cohort exhibited high disease severity, with a mean SOFA score of 9.8, a mechanical ventilation rate of 78.5%, and 49 patients (22.0%) undergoing continuous renal replacement therapy (CRRT). Among 385 positive microbiological cultures out of 991 specimens, Gram-negative bacteria accounted for 82.8%, with Acinetobacter baumannii and Klebsiella pneumoniae being the most prevalent pathogens. Escherichia coli and Klebsiella pneumoniae maintained relatively high susceptibility to amikacin, at 92.1% and 61.5%, respectively. Amikacin was predominantly initiated as empirical therapy (84.7%) with a median treatment duration of 9 days. No statistically significant difference was observed in the initial amikacin dose between non-dialysis and dialysis patients (mean 14.7 mg/kg vs. 14.3 mg/kg; p=0.37). The amikacin dose was positively correlated with CrCl in the non-dialysis group (r = 0.344; p<0.001), whereas no statistically significant linear correlation was found in the dialysis group. Overall, 74.5% of patients were clinically stable at hospital discharge. Conclusion: In the intensive care units, amikacin was predominantly prescribed empirically for severely ill patients; however, the mean initial dose (14.3 - 14.7mg/kg) remained lower than current recommendations for critically ill populations, with no distinct differentiation in dosing regimens between dialysis and non-dialysis patients. These findings highlight the need to establish standardized amikacin dosing guidelines stratified by renal function and dialysis status to optimize individualized therapy in critically ill patients.