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\begin{document}

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



\author[1]{Michael THY}%
\author[2]{Jerome Naudin}%
\author[2]{Mathieu Genuini}%
\author[3]{Stephane Leteurtre}%
\author[3]{Morgan Recher}%
\author[4]{Mehdi Oualha}%
\affil[1]{Université Paris Cité}%
\affil[2]{Robert-Debré Mother-Child University Hospital}%
\affil[3]{Lille University Hospital Center}%
\affil[4]{AP-HP}%


\vspace{-1em}



  
  \date{May 22, 2024}


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\begin{abstract}
\textbf{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.
\textbf{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). \textbf{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. \textbf{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%
\end{abstract}%



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