Association between augmented renal clearance and clinical outcomes in patients receiving beta-lactam antibiotic therapy by continuous or intermittent infusion: a nested cohort study of the BLING-II randomised, placebo-controlled, clinical trial

作者：Udy, Andrew A.^*; Dulhunty, Joel M.; Roberts, Jason A.; Davis, Joshua S.; Webb, Steven A. R.; Bellomo, Rinaldo; Gomersall, Charles; Shirwadkar, Charudatt; Eastwood, Glenn M.; Myburgh, John; Paterson, David L.; Starr, Therese; Paul, Sanjoy K.; Lipman, Jeffrey

来源：International Journal of Antimicrobial Agents, 2017, 49(5): 624-630.

DOI：10.1016/j.ijantimicag.2016.12.022

• Augmented renal clearance
• beta-Lactams
• Sepsis
• Critical illness

Augmented renal clearance (ARC) is knownto influence beta-lactam antibiotic pharmacokinetics. This substudy of the BLING-II trial aimed to explore the association between ARC and patient outcomes in a large randomised clinical trial. BLING-II enrolled 432 participantswith severe sepsis randomised to receive beta-lactam therapy by continuous or intermittent infusion. An 8-h creatinine clearance (CLCr) measured on Day 1 was used to identify ARC, defined as CLCr = 130 mL/ min. Patients receiving any form of renal replacement therapy were excluded. Primary outcome was alive ICU-free days at Day 28. Secondary outcomes included 90-day mortality and clinical cure at 14 days following antibiotic cessation. A total of 254 patientswere included, among which 45 (17.7%) manifested ARC [median (IQR) CLCr 165 (144-198) mL/min]. ARC patients were younger (P < 0.001), more commonly male (P = 0.04) and had less organ dysP < 0.001). There was no difference in ICU-free days atDay 28 [ARC, 21 (12-24) days; no ARC, 21 (11-25) days; P = 0.89], although clinical cure was significantly greater in the unadjusted analysis in those manifesting ARC [33/ 45 (73.3%) vs. 115/ 209 (55.0%) P = 0.02]. This was attenuated in the multivariable analysis. No difference was noted in 90-day mortality. There were no statistically significant differences in clinical outcomes in ARC patients according to the dosing strategy employed. In this substudy of a large clinical trial of beta-lactam antibiotics in severe sepsis, ARC was not associated with any differences in outcomes, regardless of dosing strategy.

• 出版日期2017-5