کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
8738628 | 1591731 | 2018 | 29 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Association between augmented renal clearance, antibiotic exposure and clinical outcome in critically ill septic patients receiving high doses of β-lactams administered by continuous infusion: a prospective observational study
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کلمات کلیدی
موضوعات مرتبط
علوم زیستی و بیوفناوری
ایمنی شناسی و میکروب شناسی
میکروبیولوژی و بیوتکنولوژی کاربردی
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چکیده انگلیسی
This study assessed whether augmented renal clearance (ARC) impacts negatively on antibiotic concentrations and clinical outcomes in patients treated by high-dose β-lactams administered continuously. Over a 9-month period, all critically ill patients without renal impairment treated by one of the monitored β-lactams for a documented infection were eligible. During the first 3 days of antibiotic therapy, every patient underwent 24-h CLCr measurements and therapeutic drug monitoring. The main outcome was the rate of β-lactam underdosing, defined as a free drug concentration <4âÃâMIC of the known pathogen. Secondary outcomes were rates of subexposure for β-lactams and therapeutic failure. The performance of CLCr in predicting underdosing was assessed by a ROC curve, and multivariable logistic regression was performed to determine risk factors for subexposure and therapeutic failure. A total of 79 patients were included and 235 samples were analysed. The rate of underdosing<4ÃMIC was 12%, with a significant association with CLCr (Pâ<0.0001). A threshold of CLCrââ¥â170âmL/min had a sensitivity and specificity of 0.93 (95% CI 0.77-0.99) and 0.65 (95% CI 0.58-0.71) for predicting β-lactam underdosing<4ÃMIC. Mean CLCr values â¥170âmL/min were significantly associated with subexposure<4xMIC [ORâ=â10.1 (2.4-41.6); Pâ=â0.001]. Patients with subexposure<4ÃMIC presented higher rates of therapeutic failure [ORâ=â6.3 (1.2-33.2); Pâ=â0.03]. Mean CLCr values â¥170âmL/min remain a risk factor for subexposure to β-lactams despite high doses of β-lactams administered continuously. β-Lactam subexposure was associated with higher rates of therapeutic failure in septic critically ill patients.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: International Journal of Antimicrobial Agents - Volume 51, Issue 3, March 2018, Pages 443-449
Journal: International Journal of Antimicrobial Agents - Volume 51, Issue 3, March 2018, Pages 443-449
نویسندگان
Cédric Carrié, Laurent Petit, Nicolas d'Houdain, Noemie Sauvage, Vincent Cottenceau, Melanie Lafitte, Cecile Foumenteze, Quentin Hisz, Deborah Menu, Rachel Legeron, Dominique Breilh, Francois Sztark,