| Autor: |
Jensen, Jens-Ulrik Stæhr, Hein, Lars, Lundgren, Bettina, Bestle, Morten Heiberg, Mohr, Thomas, Andersen, Mads Holmen, Thornberg, Klaus Julius, Løken, Jesper, Steensen, Morten, Fox, Zoë, Tousi, Hamid, Søe-Jensen, Peter, Lauritsen, Anne Øberg, Strange, Ditte Gry, Reiter, Nanna, Thormar, Katrin, Fjeldborg, Paul Christian, Larsen, Kim Michael, Drenck, Niels-Erik, Johansen, Maria Egede |
| Zdroj: |
BMJ Open; Mar2012, Vol. 2 Issue 2, Special section p1-8, 8p |
| Abstrakt: |
Objectives: To explore whether a strategy of more intensive antibiotic therapy leads to emergence or prolongation of renal failure in intensive care patients. Design: Secondary analysis from a randomised antibiotic strategy trial (the Procalcitonin And Survival Study). The randomised arms were conserved from the primary trial for the main analysis. Setting: Nine mixed surgical/medical intensive care units across Denmark. Participants: 1200 adult intensive care patients, 18+ years, expected to stay +24 h. Exclusion criteria: bilirubin >40 mg/dl, triglycerides >1000 mg/dl, increased risk from blood sampling, pregnant/breast feeding and psychiatric patients. Interventions: Patients were randomised to guideline-based therapy ('standard-exposure' arm) or to guideline-based therapy supplemented with antibiotic escalation whenever procalcitonin increased on daily measurements ('high-exposure' arm). Main outcome measures: Primary end point: estimated glomerular filtration rate (eGFR) <60 ml/ min/1.73 m². Secondary end points: (1) delta eGFR after starting/stopping a drug and (2) RIFLE criterion Risk 'R', Injury 'I' and Failure 'F'. Analysis was by intention to treat. Results: 28-day mortality was 31.8% and comparable Jensen et al, Crit Care Med 2011). A total of 3672/ 7634 (48.1%) study days during follow-up in the high-exposure versus 3016/6949 (43.4%) in the 'standard-exposure arm were spent with eGFR <60 ml/min/ 1.73 m², p<0.001. In a multiple effects model, 3 piperacillin/tazobactam was identified as causing the lowest rate of renal recovery of all antibiotics used: 1.0 ml/min/1.73 m²/24 h while exposed to this drug 95% CI 0.7 to 1.3 ml/min/1.73 m²/24 h) vs meropenem: 2.9 ml/min/1.73 m²/24 h (2.5 to 3.3 ml/ min/1.73 m²/24 h)); after discontinuing piperacillin/ tazobactam, the renal recovery rate increased: 2.7 ml/min/1.73 m²/24 h (2.3 to 3.1 ml/min/1.73 m² /24 h)). eGFR <60 ml/min/1.73 m² in the two groups at entry and at last day of follow-up was 57% versus 55% and 41% versus 39%, respectively. Conclusions: Piperacillin/tazobactam was identified as a cause of delayed renal recovery in critically ill patients. This nephrotoxicity was not observed when using other beta-lactam antibiotics. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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