Department of Pharmacy, Spartanburg Medical Center, Spartanburg, South Carolina, USA.
Department of Surgery, Spartanburg Medical Center, Spartanburg, South Carolina, USA.
Surg Infect (Larchmt). 2024 Mar;25(2):155-159. doi: 10.1089/sur.2023.204. Epub 2024 Feb 9.
Augmented renal clearance (ARC) is a phenomenon observed in critically ill patients, leading to supraphysiologic drug clearance and concern for suboptimal antibiotic concentrations. The purpose of this study was to compare the clinical outcomes of our institutional protocolized antibiotic dosing regimen in critically ill patients with bacteremia and ARC compared with critically ill patients without ARC. We performed a retrospective study comparing the efficacy of an institutional protocolized antibiotic dosing regimen in critically ill patients with bacteremia and ARC compared with critically ill patients without ARC. The primary end point was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, days requiring mechanical ventilation, ICU length of stay (LOS), hospital LOS, development of drug resistance to index antibiotic agent, and documented clearance of blood cultures within 72 hours. There were 75 patients included in this study. Twenty percent of patients in the ARC group died in the hospital versus 31% in the non-ARC group (p = 0.26). The results for the ARC group versus the non-ARC group for the secondary outcomes of ICU mortality (20% vs. 26%; p = 0.56), ICU LOS (14.7 days vs. 7 days; p = 0.07), hospital LOS (28.3 days vs. 21.6 days; p = 0.03), days requiring mechanical ventilation (14 days vs. 12 days; p = 0.49), duration of antibiotic therapy (7.5 days vs. 9.0 days; p = 0.39), documented clearance of blood cultures within 72 hours (41% vs. 33%; p = 0.56), and the development of drug resistance to the index antibiotic agent (0% vs. 0%; p > 0.99) were also calculated. Among critically ill patients with bacteremia and ARC, there was no difference in in-hospital mortality compared with critically ill patients without ARC. There was a difference in hospital LOS, with a shorter duration of stay for the non-ARC group. There was no development of multi-drug-resistant organisms in either group.
增强的肾清除率（ARC）是危重病患者中观察到的一种现象，导致药物清除率高于生理水平，并担心抗生素浓度不理想。本研究的目的是比较我们机构制定的抗生素剂量方案在伴有 ARC 的菌血症危重病患者与不伴有 ARC 的危重病患者的临床结局。
我们进行了一项回顾性研究，比较了伴有 ARC 的菌血症危重病患者与不伴有 ARC 的危重病患者的机构制定的抗生素剂量方案的疗效。主要终点是住院死亡率。次要结局包括重症监护病房（ICU）死亡率、机械通气天数、ICU 住院时间（LOS）、医院 LOS、指数抗生素药物耐药性的发展以及 72 小时内血培养清除情况。
本研究共纳入 75 例患者。ARC 组 20%的患者在医院死亡，而非 ARC 组为 31%（p=0.26）。ARC 组与非 ARC 组的次要结局 ICU 死亡率（20%比 26%；p=0.56）、ICU LOS（14.7 天比 7 天；p=0.07）、医院 LOS（28.3 天比 21.6 天；p=0.03）、机械通气天数（14 天比 12 天；p=0.49）、抗生素治疗持续时间（7.5 天比 9.0 天；p=0.39）、72 小时内血培养清除情况（41%比 33%；p=0.56）和指数抗生素药物耐药性的发展（0%比 0%；p>0.99）也进行了计算。
在伴有 ARC 的菌血症危重病患者中，与不伴有 ARC 的危重病患者相比，住院死亡率无差异。非 ARC 组的住院时间较短。两组均未出现多药耐药菌。
