Antibiotics, Pneumonia
Conditions
Keywords
Antibiotics, Pneumonia, broncho-alveolar lavage
Brief summary
Respiratory infections are common and sometimes very severe. An insufficient dosage of the antibiotic could lead to a treatment failure A correct plasmatic antibiotic concentration is not a guarantee of a clinical success as it could not be a reflect of pulmonary concentration. The aim of this study is to determinate the predictive factors of pulmonary penetration of antibiotics in patients with a beta lactamines failure and who undergoes a flexible bronchoscopy.
Detailed description
To check if pulmonary concentrations of antibiotic are enough we will measure antibiotic concentration in the broncho-alveolar lavage (BAL). This technique which is clinically relevant and reliable could determinate the pulmonary diffusion level for antibiotics by calculating the ratio between plasmatic and intra-alveolar antibiotic concentration. This ratio will be correlated with potential limitation factors of pulmonary diffusion as respiratory diseases (COPD, cystic fibrosis, fibrosis…), sepsis, hypoalbuminemia. We have chosen to study the beta lactamin antibiotics because they are the most frequently used in pneumonia. Moreover, the beta lactamins pulmonary diffusion is likely to be the lowest. Finally, for patients with a known pathogen, we will divide this pulmonary concentration with minimal inhibitory concentration (MIC). Indeed, in severe pneumonia, to be sure of bactericidal activity, a pulmonary concentration of beta lactamines should be always higher than 4 to 5 times MIC.
Interventions
BIOLOGICALmeasure of intra-alveolar antibiotic concentration in µg/ml
included patients will have a broncho-alveolar lavage (BAL) to measure intra-alveolar antibiotic concentration, and a blood test to measure plasmatic concentration
PROCEDUREbroncho-alveolar lavage (BAL)
included patients will have a broncho-alveolar lavage (BAL) to measure intra-alveolar antibiotic concentration, and a blood test to measure plasmatic concentration
BIOLOGICALblood test to measure plasmatic antibiotic concentration in µg/ml
included patients will have a broncho-alveolar lavage (BAL) to measure intra-alveolar antibiotic concentration, and a blood test to measure plasmatic
Sponsors
Centre Hospitalier Universitaire, Amiens
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients who undergo a flexible bronchoscopic lavage and with a beta lactamines treatment as cephalosporin of 3rd generation (CEFTRIAXONE / CEFOTAXIME, CEFTAZIDIME), of 4th generation (CEFEPIM), or AMOXICILLIN-CLAVULANIC ACID, or PIPERACILLIN-TAZOBACTAM * patient major * informed and signed consent form
Exclusion criteria
* patient under chronic dialysis * patient placed under judicial protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pulmonary diffusion level for beta lactamins | on the day of the bronco-alveolar lavage | pulmonary diffusion level for beta lactamins is determined by ratio between bronchoalveolar concentration and plasmatic concentration of tested antibiotics |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| measure of apyrexia duration in days | from day of inclusion to 15 days after inclusion | measure of apyrexia duration in days |
| duration in days for regression of the biological inflammatory syndrome | from day of inclusion to 15 days after inclusion | duration in days for regression of the biological inflammatory syndrome (CRP concentration in mg/l divided by 2) |
| measure of length of hospitalisation | from day of inclusion to 15 days after inclusion | measure of length of hospitalisation in days |
| Number of deaths at 28-day | 28 days after inclusion | 28-day mortality will be measured |
| virus presence in BAL | day of bronchoalveolar lavage (BAL) | virus presence will be detected in bronchoalveolar lavage (BAL) |
Countries
France
Outcome results
None listed