Anti-infective prescribing practices in critically ill children on
continuous renal replacement therapy: a multicenter survey of
French-speaking countries
Abstract
Background Use of continuous renal replacement therapy (CRRT)
in children receiving anti-infective drugs may lead to inappropriate
concentrations with risks of treatment failure, toxicity and emergence
of multidrug-resistant bacteria. We aimed to describe anti-infective
prescribing practices in critically ill children undergoing CRRT.
Methods An online survey to assess CRRT, anti-infective
prescribing and therapeutic drug monitoring (TDM) practices was sent by
e-mail to physicians working in pediatric intensive care units (PICUs)
through the French-speaking Group of Pediatric Intensive Care and
Emergency medicine (GFRUP). Results From April 1st 2021 to May
1st 2021, 26/40 different PICUs participated in the survey,
corresponding to a response rate of 65%. Twenty-one were located in
France and five abroad. All PICU practiced CRRT mainly with Prismaflex™
System. Anti-infective prescriptions were adjusted to the presence of
CRRT in 23 (88%) PICUs mainly according to the molecular weight in 6
(23%), the molecule protein binding in 6 (23%) and the elimination
routes in 15 (58%) including the residual diuresis in 9 (35%), to the
CRRT flow in 6 (23%) and to the modality of CRRT used in 15 (58%),
PICUs. There was a wide variability noticed between PICUs and between
physicians in the same unit. Barriers to TDM were mainly an excessive
delay in obtaining results in 11 (42%) and the lack of an on-site
laboratory in 8 (31%) PICUs. Conclusions Our survey reported
wide variability in anti-infective prescribing practices in children
undergoing CRRT highlighting the gap in the knowledge and the need for
education and recommendations