Aminoglycosides for the treatment of septic shock: a propensity-based study
- PDF / 516,322 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 0 Downloads / 182 Views
RESEARCH LETTER
Open Access
Aminoglycosides for the treatment of septic shock: a propensity-based study Jean-François Llitjos1,2,3*, Simon Meslin1, Swann Bredin1, Matthieu Jamme4,5 and Frédéric Pène1,2,3
Keywords: Septic shock, Aminoglycosides, Antibiotics, Intensive care unit, Bacterial resistance, Bacteria The adequacy of initial antimicrobial treatment is a strong determinant of prognosis in septic shock. The prototypic synergistic combination of beta-lactams with aminoglycosides appears as an attractive therapeutic option, but its actual benefit remains elusive [1, 2]. We took advantage of a large comprehensive cohort of septic shock to address the impact of aminoglycosides on mortality, with respect to their pharmacodynamic and pharmacokinetic properties. We performed a retrospective single-center study over a 9-year period (2008–2016) of patients admitted to the intensive care unit (ICU) for septic shock, defined as microbiologically proven or clinically suspected infection associated with acute circulatory failure requiring vasopressors. The primary endpoint was in-ICU mortality. Patients treated or non-treated with aminoglycosides were matched in a 1:1 ratio using a logistic regressionbased propensity score including the following variables: age, gender, comorbid conditions, SAPS2, source of infection, biological findings, and organ supports at admission. Accuracy of aminoglycoside administration was characterized by the loading dose (recommended as 30 mg/kg amikacin or 6 mg/kg gentamycin/tobramycin) and the peak serum concentration (Cpeak) (targets recommended as ≥ 60 mg/L amikacin or ≥ 30 mg/L * Correspondence: [email protected] This work was performed in: Service de médecine intensive-réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique Hôpitaux de Paris, Paris, France 1 Service de médecine intensive-réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France 2 Université de Paris, Paris, France Full list of author information is available at the end of the article
gentamicin/tobramycin). Determinants of mortality were investigated in cause-specific proportional hazard model. Among the 1040 patients, 616 (59%) were administered a primary antibiotic combination regimen of beta-lactam with amikacin (379 patients, 62%), gentamycin (229 patients, 37%), or tobramycin (8 patients, 1%). The overall mortality rate was 35%. The propensity score-based matching process resulted in two cohorts of 348 patients with and without aminoglycosides (Table 1). Using the SAPS-2 score, the severity was comparable between the two groups after matching (68 points (52–85) in the aminoglycoside group versus 65 points (51–80) in the nonaminoglycoside group (p = 0.17)). Among patients with microbiologically documented infections, the adequacy of the initial antibiotic regimen increased from 82% with single beta-lactam to 92% with combination regimen (p = 0.01). In combination-treated patients,
Data Loading...
