Pinner Nathan A, Tapley Natalie G, Barber Katie E, Stover Kayla R, Wagner Jamie L
Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Birmingham, Alabama, USA.
Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA.
Open Forum Infect Dis. 2021 Apr 27;8(8):ofab212. doi: 10.1093/ofid/ofab212. eCollection 2021 Aug.
Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial.
This multicenter, retrospective cohort included hospitalized adults admitted from July 2015 to July 2017 treated with a β-lactam as definitive monotherapy against a gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): nonobese (BMI ≤29.9 kg/m) and obese (BMI ≥30.0 kg/m). The primary outcome was clinical treatment failure, and secondary outcomes were hospital length of stay, inpatient all-cause mortality, and 30-day all-cause readmission.
There were 257 (43.6%) obese patients and 332 (56.4%) nonobese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by third-generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) nonobese patients ( < .001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than nonobese patients ( = .002), but no differences were found for all-cause mortality ( = .117) or infection-related readmission (0 = 0.112).
Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients. Future studies are needed to assess the impact of therapeutic drug monitoring and specific dosing recommendations for targeted infection types.
肥胖患者药代动力学改变引发了对更差临床结局的担忧。本研究评估了接受β-内酰胺类药物治疗的肥胖患者与非肥胖患者相比是否具有更差的临床结局，并确定治疗药物监测是否有益。
这项多中心回顾性队列研究纳入了2015年7月至2017年7月住院的成年患者，这些患者接受β-内酰胺类药物作为针对革兰氏阴性杆菌的确定性单一疗法治疗≥72小时。如果缺乏源头控制或如果多重微生物感染需要>1种抗生素进行确定性治疗，则将患者排除。根据体重指数（BMI）对患者进行分类：非肥胖（BMI≤29.9kg/m）和肥胖（BMI≥30.0kg/m）。主要结局是临床治疗失败，次要结局是住院时间、住院全因死亡率和30天全因再入院率。
共纳入257例（43.6%）肥胖患者和332例（56.4%）非肥胖患者。最常见的感染是泌尿系统感染（50.9%）和呼吸道感染（31.4%）。确定性治疗以第三代头孢菌素（46.9%）和头孢吡肟（44.7%）为主。131例（51%）肥胖患者和109例（32.8%）非肥胖患者发生治疗失败（P<0.001）。肥胖和呼吸道感染源与治疗失败可能性增加独立相关。肥胖患者的住院时间比非肥胖患者长（P=0.002），但在全因死亡率（P=0.117）或感染相关再入院率方面未发现差异（P=0.112）。
接受β-内酰胺类药物治疗的肥胖患者比非肥胖患者具有更高的治疗失败率和更长的住院时间。未来需要进行研究以评估治疗药物监测的影响以及针对特定感染类型的具体给药建议。
