Clinical Outcomes of Cefepime Dosing in Patients With Pseudomonas aeruginosa Infections Undergoing Renal Replacement Therapies.

Abstract

Objective: Data regarding the efficacy of cefepime in treating patients with Pseudomonas aeruginosa infections undergoing renal replacement therapy (RRT) are limited. Therefore, we conducted a study to investigate the outcomes of recommended cefepime dosing in this population.

Methods: A retrospective descriptive cohort study was conducted between May 2015 and December 2022 on patients diagnosed with active sepsis secondary to P. aeruginosa infection, requiring cefepime treatment and undergoing RRT. The primary endpoint was 30-day all-cause mortality, with secondary endpoints including clinical cure, microbiologic cure, infection recurrence rate, and incidence of adverse events.

Results: A total of 132 patients met the inclusion criteria. Of these, 81 (62.4%) were male, with a median age of 69 years and a median BMI of 27 kg/m². The most common diagnoses were pneumonia (58.3%), followed by bacteremia (18.9%). The median minimum inhibitory concentration (MIC) of cefepime for P. aeruginosa was 2 mcg/mL. The median dose of cefepime was 2000 mg every 12 h in those undergoing continuous venovenous hemofiltration and 1000 mg every 24 h in those undergoing intermittent hemodialysis, with a median duration of therapy of 8 days. The median Charlson Comorbidity index for survivors was 9 (8-11), while it was 7.5 (5.25-9.75) for non-survivors (p = 0.754). The 30-day survival rate was achieved in 96 patients (72.7%), the clinical cure was achieved in 58.3% of subjects, and a microbiologic cure rate of 31%. The 30-day reinfection rate was 9.1%, with no documented adverse events associated with the doses used. Multivariable logistic regression analysis identified the use of vasopressors (Odds Ratio 4.6, 95% CI 1.3-17.1) and white blood cell count at the end of therapy (Odds Ratio 1.1, 95% CI 1.01-1.4) as the main predictors of all-cause mortality in this population.

Conclusion: Our results suggest that the utilized doses of cefepime in patients with P. aeruginosa infections undergoing RRT were effective. Larger study is needed to confirm our findings.