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Association between increased mortality rate and antibiotic dose adjustment in intensive care unit patients with
Marianne Silveira Camargo1,2, Sóstenes Mistro3, Márcio Galvão Oliveira3
1Post-Graduate Program in Medicine and Health, Federal University of Bahia, Rua Padre Feijó, S/N, Canela, Salvador, Bahia, Brazil. marianne_camargo@hotmail.com.
Purpose:
Adjusting the antibiotic dose based on an estimation of the glomerular filtration rate (eGFR) may result in subdosing, which may actually be significantly more problematic for intensive care unit (ICU) patients than not adjusting the dose. The aim of this study was to assess the outcomes of antibiotic dose adjustment in ICU patients with renal impairment.
Methods:
A retrospective cohort study was conducted in adult patients admitted to an ICU of a Brazilian hospital from January 2014 to December 2015. The eGFR was determined using Cockcroft-Gault and Modified Diet in Renal Disease equations for each day of hospitalization. Treatment failure was defined based on the clinical, laboratory, and radiological criteria.
Results:
A total of 126 patients were assessed to meet the inclusion criteria and subsequently enrolled in the study (19.9% of patients admitted to the ICU during the study period). Of the 168 opportunities for dose adjustment, 99 (58.9%) adjustments were made. The mean eGFR in the group with dose adjustment was lower than that in the group without dose adjustment (38.5 vs. 40.7 mL/min/1.73 m2, respectively). The treatment failure rate among patients with dose adjustment and those treated with the usual dose was 59.3 and 38.9%, respectively (p = 0.023), and the mortality rates in the respective groups were 74.1 and 55.5% (p = 0.033). An association between dose adjustment and treatment failure/mortality rates was also observed in the multivariate analysis including the prognostic score.
Conclusions:
In ICU patients with renal impairment, adjustments in antibiotic dose based on eGFR, significantly increased the risk of treatment failure and death.
Insights
Antibiotic dose adjustments in intensive care unit (ICU) patients with renal impairment based on estimated glomerular filtration rate (eGFR) were linked to higher treatment failure and mortality rates. This suggests current dosing adjustments may be detrimental for critically ill patients.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Antibiotic dosing in intensive care unit (ICU) patients with renal impairment often relies on estimated glomerular filtration rate (eGFR) adjustments.
- Suboptimal antibiotic dosing, including potential subdosing, can significantly impact patient outcomes in critical care settings.
- The clinical implications of routine antibiotic dose adjustments based on eGFR in ICU patients with renal impairment require thorough investigation.
Purpose of the Study:
- To evaluate the impact of antibiotic dose adjustments, guided by eGFR estimations, on treatment outcomes in ICU patients with renal impairment.
- To determine if adjusting antibiotic doses based on eGFR in critically ill patients with kidney dysfunction leads to improved or worsened clinical results.
Main Methods:
- A retrospective cohort study involving adult ICU patients from a Brazilian hospital between January 2014 and December 2015.
- Estimated glomerular filtration rate (eGFR) was calculated daily using Cockcroft-Gault and Modified Diet in Renal Disease equations.
- Treatment failure was assessed using clinical, laboratory, and radiological criteria.
Main Results:
- Out of 168 potential dose adjustments, 99 (58.9%) were implemented in 126 selected ICU patients.
- Patients receiving dose adjustments had a lower mean eGFR (38.5 mL/min/1.73 m²) compared to those without adjustments (40.7 mL/min/1.73 m²).
- Dose adjustment was associated with significantly higher treatment failure rates (59.3% vs. 38.9%, p=0.023) and mortality rates (74.1% vs. 55.5%, p=0.033).
Conclusions:
- Antibiotic dose adjustments based on eGFR in ICU patients with renal impairment are associated with increased risks of treatment failure and death.
- These findings challenge the current practice of routine antibiotic dose modification based on eGFR in critically ill patients with kidney dysfunction.
- Further research is warranted to refine antibiotic dosing strategies for ICU patients with varying degrees of renal impairment.
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