[Levofloxacin in the treatment of nosocomial infection in critically ill patients].

INTRODUCTION

Levofloxacin (LVX) is one of the most frequently used antibiotics in critical patients admitted to Spanish Intensive Care Units (ICU). Their use in community-acquired infections has been widely documented, while it is less frequent and known in nosocomial infections (NI).

OBJECTIVE

To describe the indications and utilization patterns of LVX in the treatment of NI in patients admitted to Spanish ICU.

MATERIAL AND METHODS

Open-label, retrospective, observational and multicenter study. All patients admitted to ICU and who were being treated for NI with LVX in the years 2004-2005 were included. A case report form (CRF) was drawn up and included demographic, infection, treatment, infectious process and patient development variables. NI-dependent LVX usage was described. A logistical regression analysis was carried out in order to identify the variables associated with a satisfactory response. Results are expressed by means of the odds ratio and a 95% confidence interval.

RESULTS

A total of 949 patients who were given LVX for the treatment of 1,103 NI were recruited in 87 ICU: 460 (41.7%) with non-mechanical ventilation associated pneumonia, 256 (23.2 %) mechanical-ventilation associated pneumonia, 107 (9.7 %) with primary or vascular catheter-related bacteremia, 47 (4.3 %) with urethral catheter-related urinary infections, 42 (3.8%) with organspace or deep surgical infections and 191 (17.3%) who had other types of infection. An APACHE II upon admission of 19.6 (SD: 8) and severe sepsis or septic shock systemic response in 50.4% of all cases. On 776 (82.7%) occasions treatment was initiated on an empirical basis and in 589 (62.1%) cases the dose of choice was of 0.5 g/ 12 h, with a mean duration of 9 days. In 738 (77.8 %) patients, LVX was used in association with other antibiotics. The clinical response by treatment end was rated as satisfactory in 67.4 % of all NI. Factors related to a non-satisfactory response were as follows: APACHE II (OR: 1.05; 95% CI: 1.028-1.078); septic shock (OR: 2.62; 95 % CI: 1.623-4.219); the requirement for changes in treatment due to poor clinical progress (OR: 66.67; 95% CI: 15.384-250), the presence of non-covered microorganisms (OR: 6.58; 95% CI: 3.663-11.765), the appearance of new resistant pathogens (OR: 6.94; 95 % CI: 2.445- 19.608) or the diagnosis of a new infection (OR: 3.68; 95% CI: 1.504-8.929); solid neoplasm (OR: 1.98; 95% CI: 1.156-3.899); chronic liver disease (OR: 3.11; 95 % CI: 1.429-8.475) and the absence of etiology confirmation (OR: 2.39; 95 % CI: 1.624-3.510). One or more adverse events which were possibly or probably related to the use of LVX were detected in 104 (11.0%) patients. Total intra-ICU mortality amounted to 26.1%, while the accumulated in-hospital mortality was 33.8%.

CONCLUSIONS

LVX is a common therapeutic option in the treatment of nosocomial infections in critical patients. It is predominantly used in an empirical manner, at a dose of 0.5 g every 12 hours and in combination with other antibiotics.