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Abstract

Sepsis is the main cause of death in intensive care unit. Intensive care patients undergo numerous physiological changes, due to the various therapeutic interventions (notably vascular filling), resulting in changes in the distribution and metabolization of antibiotics. The pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics are therefore altered, with an increase in their volume of distribution and changes in their clearance, absorption and tissue penetration. Antibiotics need to be started quickly, and the methods of administration need to be optimized according to the site of infection, their distribution, and the bacterium and its sensitivity to antibiotics.) Antibiotics from the beta-lactam family are the most used in intensive care; they are time-dependent and must therefore be administered by continuous infusion to achieve the objective of time above MIC 100% of the time.
Therapeutic drug monitoring (TDM) is essential for certain classes of antibiotic to assess their efficacy and reduce their toxicity. However, the diffusion of antibiotics into infected sites varies from one antibiotic to another, and PK/PD data are not always sufficiently well known to allow individualization of antibiotic treatment.