Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Int J Artif Organs. 2024 Sep;47(9):653-658. doi: 10.1177/03913988241264463. Epub 2024 Jul 30.
The clinical efficacy and safety of ertapenem use in patients undergoing renal replacement therapies (RRT) are not well-documented. Therefore, we aimed to investigate the safety and efficacy of ertapenem in patients with sepsis secondary to Enterobacterales who are undergoing RRT.
A retrospective cohort study was conducted on patients who met the inclusion criteria at our hospital between May 2015 and December 2021. The primary endpoint was 30-day mortality. Secondary endpoints included clinical cure, microbiologic cure, recurrence rate, and incidence of seizures.
During the study period, 158 patients met the inclusion criteria. Of these, 86 were male (54.4%), the mean age was 66.4 ± 13.8 years, and the mean weight was 77 ± 22.4 kg. The most common diagnosis was bacteremia in 48 (30.4%) subjects, followed by urinary tract infection in 39 (24.7%) subjects, and pneumonia in 35 (22.2%) patients. The most isolated pathogens were , followed by species. The median ertapenem dose was 0.5 g intravenously (IV) daily in those who received intermittent hemodialysis (IHD) and 1 g IV daily for those who received continuous veno-venous hemofiltration (CVVH). The 30-day mortality rate was 24%, the clinical cure rate was 89.2%, the microbiologic cure rate was 82%, the 30-day recurrence rate was 41.1%, and the incidence of seizures was 2.5%. Multivariate logistic regression analysis indicated that age (OR 1.04 [95% CI: 1.003-1.075]), being critically ill at therapy initiation (OR 2.9 [95% CI: 1.1-7.5]), and Enterobacterales other than and (OR 3.8 [95% CI: 1.1-12.5]) were significant independent risk factors associated with mortality in this population. Ertapenem dose was not associated with mortality.
Our findings suggest that the commonly used doses of ertapenem in patients undergoing IHD and CVVH are clinically effective but may pose a higher risk of seizures. A comprehensive pharmacokinetic study is needed to determine the most effective and safe dose for this population.
替加环素在接受肾脏替代治疗（RRT）的患者中的临床疗效和安全性尚未得到充分证实。因此，我们旨在研究 RRT 患者中因肠杆菌科引起的脓毒症使用替加环素的安全性和疗效。
对 2015 年 5 月至 2021 年 12 月期间在我院符合纳入标准的患者进行回顾性队列研究。主要终点为 30 天死亡率。次要终点包括临床治愈率、微生物学治愈率、复发率和癫痫发作发生率。
在研究期间，共有 158 名患者符合纳入标准。其中 86 名男性（54.4%），平均年龄为 66.4±13.8 岁，平均体重为 77±22.4kg。最常见的诊断是 48 例（30.4%）患者的菌血症，其次是 39 例（24.7%）患者的尿路感染和 35 例（22.2%）患者的肺炎。最常见的分离病原体是 ，其次是 种。接受间歇性血液透析（IHD）的患者替加环素的中位剂量为 0.5g 静脉内（IV）每日一次，接受连续静脉-静脉血液滤过（CVVH）的患者替加环素的剂量为 1g IV 每日一次。30 天死亡率为 24%，临床治愈率为 89.2%，微生物学治愈率为 82%，30 天复发率为 41.1%，癫痫发作发生率为 2.5%。多变量逻辑回归分析表明，年龄（OR 1.04 [95%CI：1.003-1.075]）、治疗开始时病危（OR 2.9 [95%CI：1.1-7.5]）和肠杆菌科以外的 和 （OR 3.8 [95%CI：1.1-12.5]）是该人群死亡的显著独立危险因素。替加环素剂量与死亡率无关。
我们的研究结果表明，IHD 和 CVVH 患者中常用剂量的替加环素具有临床疗效，但可能会增加癫痫发作的风险。需要进行全面的药代动力学研究，以确定该人群的最佳有效且安全剂量。
