Kidney failure related to broad-spectrum antibiotics in critically ill patients: secondary end point results from a 1200 patient randomised trial
| Autor: | Jesper Kjaer, Peter Søe-Jensen, Hamid Tousi, Morten H. Bestle, Morten Steensen, Anne Øberg Lauritsen, Nanna Reiter, Paul Christian Fjeldborg, Lars Hein, Kim M Larsen, Jens D Lundgren, Mads H. Andersen, Zoe Fox, Ditte Strange, Maria Egede Johansen, Jesper Grarup, Thomas Mohr, Klaus J. Thornberg, Jens-Ulrik Stæhr Jensen, Bettina Lundgren, Christian Østergaard, Lene Ryom Nielsen, Katrin Thormar, Jesper Løken, Niels-Erik Drenck |
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| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | BMJ Open Jensen, J-U S, Hein, L, Lundgren, B, Bestle, M H, Mohr, T T, Andersen, M H, Thornberg, K J, Løken, J, Steensen, M, Fox, Z, Tousi, H, Søe-Jensen, P, Lauritsen, A Ø, Strange, D G, Reiter, N, Thormar, K, Fjeldborg, P C, Larsen, K M, Drenck, N-E, Johansen, M E, Nielsen, L R, Ostergaard, C, Kjær, J B, Grarup, J & Lundgren, J 2012, ' Kidney failure related to broad-spectrum antibiotics in critically ill patients : secondary end point results from a 1200 patient randomised trial ', BMJ Open, vol. 2, no. 2, pp. e000635 . https://doi.org/10.1136/bmjopen-2011-000635 |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2011-000635 |
| Popis: | 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) Article summary Article focus To determine whether an increased exposure to broad-spectrum antibiotics causes renal failure in intensive care patients. To find out whether some of the antibiotics used in the interventional arm were more prone to cause renal failure. Key messages More days with renal failure were observed in patients in the highly antibiotic exposed arm. Administration of piperacillin/tazobactam caused the lowest rate of renal recovery of all analysed drugs and when this drug was discontinued, renal function recovered at a fast rate. Use of piperacillin/tazobactam in intensive care patients can cause a slow renal recovery and this toxic effect seems at least partially reversible. Strengths and limitations of this study The study is a randomised controlled trial with a high sample size and high rate of follow-up and it is the first to systematically investigate the renal toxicity of several of the analysed antibiotics. Existing end points for acute renal failure could not capture renal failure that emerged from baseline and forth, so other end points had to be designed. The study was not designed to detect persistent renal failure and more severe degrees of renal failure. |
| Databáze: | OpenAIRE |
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