کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5667034 | 1591743 | 2017 | 7 صفحه PDF | دانلود رایگان |
- 17.7% of patients included in the substudy manifested augmented renal clearance (ARC).
- ARC patients were younger, more commonly male and had less organ dysfunction.
- No difference in ICU-free days at Day 28 or 90-day mortality between those with and without ARC.
- Clinical cure was greater in unadjusted analysis in those with ARC; this was attenuated in multivariable analysis.
- No statistically significant differences in clinical outcomes in ARC patients according to dosing strategy.
Augmented renal clearance (ARC) is known to influence β-lactam antibiotic pharmacokinetics. This substudy of the BLING-II trial aimed to explore the association between ARC and patient outcomes in a large randomised clinical trial. BLING-II enrolled 432 participants with severe sepsis randomised to receive β-lactam therapy by continuous or intermittent infusion. An 8-h creatinine clearance (CLCr) measured on Day 1 was used to identify ARC, defined as CLCrââ¥â130âmL/min. Patients receiving any form of renal replacement therapy were excluded. Primary outcome was alive ICU-free days at Day 28. Secondary outcomes included 90-day mortality and clinical cure at 14 days following antibiotic cessation. A total of 254 patients were included, among which 45 (17.7%) manifested ARC [median (IQR) CLCr 165 (144-198) mL/min]. ARC patients were younger (Pâ<0.001), more commonly male (Pâ=â0.04) and had less organ dysfunction (Pâ<0.001). There was no difference in ICU-free days at Day 28 [ARC, 21 (12-24) days; no ARC, 21 (11-25) days; Pâ=â0.89], although clinical cure was significantly greater in the unadjusted analysis in those manifesting ARC [33/45 (73.3%) vs. 115/209 (55.0%) Pâ=â0.02]. This was attenuated in the multivariable analysis. No difference was noted in 90-day mortality. There were no statistically significant differences in clinical outcomes in ARC patients according to the dosing strategy employed. In this substudy of a large clinical trial of β-lactam antibiotics in severe sepsis, ARC was not associated with any differences in outcomes, regardless of dosing strategy.
Journal: International Journal of Antimicrobial Agents - Volume 49, Issue 5, May 2017, Pages 624-630