头孢他啶-阿维巴坦在脓毒症患者中使用肾脏替代疗法的微生物学结果

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-05-05 DOI:10.1111/hdi.13090

Wasim S. El Nekidy, Mooza Al Ali, Emna Abidi, Islam M. Ghazi, Nizar Attallah, Rania El Lababidi, Mohamad Mooty, Muriel Ghosn, Jihad Mallat

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引用次数: 0

摘要

多药耐药患者使用头孢他啶-阿维巴坦(CEF/AVI)的推荐剂量和肾替代疗法(RRTs)尚未在临床研究中得到验证。本研究的目的是评估在使用RRT的患者中使用推荐的CEF/AVI剂量对菌血症和肺炎的微生物治疗效果。方法2018年9月15日至2022年3月15日在我院进行回顾性观察研究。主要目的是确定微生物治疗。次要终点为临床治愈、30天复发率、30天全因死亡率。结果56例患者符合纳入标准，其中男性36例(64.3%)，中位年龄69(59.5-79.3)岁，中位体重69 (60-83.8)kg。肺炎占34例(60.7%)。32例(57%)患者获得微生物治疗。然而，微生物治疗组有23例(71.9%)患者获得临床治愈，而微生物治疗失败组有12例(50%)患者获得临床治愈(p = 0.094)。微生物治疗组30天复发2例(6.3%)，微生物治疗失败组3例(12.5%)(p = 0.673)。此外，两组30天全因死亡率分别为18例(56.3%)和10例(41.7%)(p = 0.28)。使用连续静脉-静脉血液滤过(CVVH)的患者最多使用的剂量为1.25 g / 8h，而使用间歇血液透析(IHD)的患者最多使用的剂量为1.25 g / 24h。多因素logistic回归分析显示，菌血症(OR为41.5[3.77-46])、肠杆菌(OR为5.4[1.04-27.9])和药物日剂量(OR为2.33[1.15-4.72])与微生物治愈率独立相关。结论头孢他啶-阿维巴坦对CVVH和IHD患者的微生物治疗取决于菌血症诊断、日剂量和细菌种类。这些发现需要在更大的前瞻性研究中得到证实，对那些使用RRT的人没有建议。

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Microbiologic outcomes of ceftazidime-avibactam dosing in patients with sepsis utilizing renal replacement therapies

Introduction

The suggested dose of ceftazidime-avibactam (CEF/AVI) in patient with multidrug resistant organisms and utilizing renal replacement therapies (RRTs) is not validated in clinical studies. The objective of this study was to evaluate the microbiologic cure of bacteremia and pneumonia using the recommended CEF/AVI dosing in patients utilizing RRT.

Methods

A retrospective observational study conducted at our institution between September 15, 2018 and March 15, 2022. The primary end point was to determine the microbiologic cure. The secondary end points were the clinical cure, 30-day recurrence, 30-day all cause mortality.

Results

Fifty-six patients met the inclusion criteria, 36 (64.3%) were males, the median age was 69 (59.5–79.3) years, and the median weight was 69 (60–83.8) kg. Pneumonia represented 34 (60.7%) of infections. Microbiologic cure was achieved in 32 (57%) subjects. However, clinical cure was achieved in 23 (71.9%) patients in the microbiologic cure group versus 12 (50%) in the microbiologic failure group (p = 0.094). The 30-day recurrence occurred in 2 (6.3%) patients in the microbiologic cure group versus 3 (12.5%) in the microbiologic failure group (p = 0.673). Further, the 30-day all-cause mortality was 18 (56.3%) versus 10 (41.7%) in both groups respectively (p = 0.28). The most used dose in patients utilizing continuous veno-venous hemofiltration (CVVH) was 1.25 g q8h, while the dose was 1.25 g q24h in those who utilized intermittent hemodialysis (IHD). The multivariate logistic regression indicated that bacteremia (OR 41.5 [3.77–46]), Enterobacterales (OR 5.4 [1.04–27.9]), and the drug daily dose (OR 2.33 [1.15–4.72]) were independently associated with microbiologic cure.

Conclusion

Microbiologic cure of ceftazidime-avibactam in patient utilizing CVVH and IHD is dependent on bacteremia diagnosis, the drug daily dose, and bacterial species. These findings need to be replicated in a larger prospective study, with no recommendations in those utilizing RRT.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.