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Anti-infective prescribing practices in critically ill children on continuous renal replacement therapy: a multicenter survey of French-speaking countries

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Abstract

Background

Use of continuous renal replacement therapy in children receiving anti-infective drugs may lead to inappropriate concentrations with risks related to treatment failure, toxicity and emergence of multidrug-resistant bacteria. We aimed to describe anti-infective prescribing practices in critically ill children undergoing continuous renal replacement therapy.

Methods

An online survey to assess continuous renal replacement therapy, anti-infective prescribing and therapeutic drug monitoring practices was sent by e-mail to physicians working in pediatric intensive care units through the French-speaking Group of Pediatric Intensive Care and Emergency medicine (GFRUP).

Results

From April 1st, 2021 to May 1st, 2021, 26/40 pediatric intensive care units participated in the survey, corresponding to a response rate of 65%. Twenty-one were located in France and five abroad. All pediatric intensive care units administered continuous renal replacement therapy, primarily with Prismaflex™ System. Anti-infective prescriptions were adjusted to the presence of continuous renal replacement therapy in 23 (88%) pediatric intensive care units mainly according to molecular weight in 6 (23%), molecule protein binding in 6 (23%) and elimination routes in 15 (58%) including residual diuresis in 9 (35%), to the continuous renal replacement therapy flow in 6 (23%) and to the modality of continuous renal replacement therapy used in 15 (58%), pediatric intensive care units. There was broad variability among pediatric intensive care units and among physicians within the same unit. Barriers to therapeutic drug monitoring were mainly an excessive delay in obtaining results in 11 (42%) and the lack of an on-site laboratory in 8 (31%) pediatric intensive care units.

Conclusions

Our survey reported wide variability in anti-infective prescribing practices in children undergoing continuous renal replacement therapy, thus highlighting a gap in knowledge and the need for education and recommendations.

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Data availability

Data discussed in this paper are available on reasonable request to the authors.

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Acknowledgements

Thanks to all participating pediatric ICUs from : Bruxelles, Caen, Clermont Ferrand, Geneve, Grenoble, La Réunion, Marseille, Lausanne, Liège, Lille, Lyon, Mayotte, Montpellier, Montréal, Nancy, Nantes, Paris (Kremlin-Bicêtre, Necker-Enfants Malades, Robert Debré, Trousseau), Reims, Rennes, Rouen, Strasbourg, Toulouse, Tours.

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Authors and Affiliations

  1. Department of Intensive Care and Infectious Diseases, AP-HP, Université Paris Cité, Bichat Hospital, Paris, France

    Michaël Thy

  2. Pediatric Intensive Care Unit, AP-HP, Université Paris Cité, Necker-Enfants Malades Hospital, Paris, France

    Michaël Thy & Mehdi Oualha

  3. EA 7323-Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France

    Michaël Thy & Mehdi Oualha

  4. Pediatric Intensive Care Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France

    Jérôme Naudin & Mathieu Genuini

  5. Pediatric Intensive Care Transport Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France

    Mathieu Genuini

  6. Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France

    Stéphane Leteurtre & Morgan Recher

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  1. Michaël Thy
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the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP)

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Correspondence to Michaël Thy.

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Thy, M., Naudin, J., Genuini, M. et al. Anti-infective prescribing practices in critically ill children on continuous renal replacement therapy: a multicenter survey of French-speaking countries. J Nephrol 36, 2541–2547 (2023). https://doi.org/10.1007/s40620-023-01762-1

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