Cargando…

Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study

The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of th...

Descripción completa

Detalles Bibliográficos
Autores principales: Sirard, Stéphanie, Abou Chakra, Claire Nour, Langlois, Marie-France, Perron, Julie, Carignan, Alex, Valiquette, Louis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602836/
https://www.ncbi.nlm.nih.gov/pubmed/33081192
http://dx.doi.org/10.3390/antibiotics9100707
_version_ 1783603777184464896
author Sirard, Stéphanie
Abou Chakra, Claire Nour
Langlois, Marie-France
Perron, Julie
Carignan, Alex
Valiquette, Louis
author_facet Sirard, Stéphanie
Abou Chakra, Claire Nour
Langlois, Marie-France
Perron, Julie
Carignan, Alex
Valiquette, Louis
author_sort Sirard, Stéphanie
collection PubMed
description The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of their antimicrobial treatment: 80–100% = good, 20–79% = moderate, and 0–19% = poor. The association between antimicrobial adjustment and a composite of unfavourable outcomes [intensive care unit stay ≥72 h, duration of sepsis >3 days, length of stay ≥7 days or all-cause 30-day mortality] was assessed using logistic regression. Of 110 included episodes, the adjustment was rated good in 47 (43%) episodes, moderate in 31 (28%), and poor in 32 (29%). Older age, Pitt bacteremia score ≥2, sepsis on day 1, and infection site were independent risk factors for unfavourable outcomes. The level of appropriateness was not associated with unfavourable outcomes. The number of antimicrobials, consultation with an infectious disease specialist, blood urea nitrogen 7–10.9 mmol/L, and hemodialysis were significantly associated with adjusted antimicrobial dosing. While the severity of the infection had a substantial impact on the measured outcomes, we did not find an association between dosing optimization and better outcomes.
format Online
Article
Text
id pubmed-7602836
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-76028362020-11-01 Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study Sirard, Stéphanie Abou Chakra, Claire Nour Langlois, Marie-France Perron, Julie Carignan, Alex Valiquette, Louis Antibiotics (Basel) Article The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of their antimicrobial treatment: 80–100% = good, 20–79% = moderate, and 0–19% = poor. The association between antimicrobial adjustment and a composite of unfavourable outcomes [intensive care unit stay ≥72 h, duration of sepsis >3 days, length of stay ≥7 days or all-cause 30-day mortality] was assessed using logistic regression. Of 110 included episodes, the adjustment was rated good in 47 (43%) episodes, moderate in 31 (28%), and poor in 32 (29%). Older age, Pitt bacteremia score ≥2, sepsis on day 1, and infection site were independent risk factors for unfavourable outcomes. The level of appropriateness was not associated with unfavourable outcomes. The number of antimicrobials, consultation with an infectious disease specialist, blood urea nitrogen 7–10.9 mmol/L, and hemodialysis were significantly associated with adjusted antimicrobial dosing. While the severity of the infection had a substantial impact on the measured outcomes, we did not find an association between dosing optimization and better outcomes. MDPI 2020-10-16 /pmc/articles/PMC7602836/ /pubmed/33081192 http://dx.doi.org/10.3390/antibiotics9100707 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sirard, Stéphanie
Abou Chakra, Claire Nour
Langlois, Marie-France
Perron, Julie
Carignan, Alex
Valiquette, Louis
Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title_full Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title_fullStr Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title_full_unstemmed Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title_short Is Antimicrobial Dosing Adjustment Associated with Better Outcomes in Patients with Severe Obesity and Bloodstream Infections? An Exploratory Study
title_sort is antimicrobial dosing adjustment associated with better outcomes in patients with severe obesity and bloodstream infections? an exploratory study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602836/
https://www.ncbi.nlm.nih.gov/pubmed/33081192
http://dx.doi.org/10.3390/antibiotics9100707
work_keys_str_mv AT sirardstephanie isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy
AT abouchakraclairenour isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy
AT langloismariefrance isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy
AT perronjulie isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy
AT carignanalex isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy
AT valiquettelouis isantimicrobialdosingadjustmentassociatedwithbetteroutcomesinpatientswithsevereobesityandbloodstreaminfectionsanexploratorystudy