Cargando…
Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams
BACKGROUND: Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial. METHODS: Th...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391092/ https://www.ncbi.nlm.nih.gov/pubmed/34458387 http://dx.doi.org/10.1093/ofid/ofab212 |
_version_ | 1783743189829550080 |
---|---|
author | Pinner, Nathan A Tapley, Natalie G Barber, Katie E Stover, Kayla R Wagner, Jamie L |
author_facet | Pinner, Nathan A Tapley, Natalie G Barber, Katie E Stover, Kayla R Wagner, Jamie L |
author_sort | Pinner, Nathan A |
collection | PubMed |
description | BACKGROUND: Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial. METHODS: This multicenter, retrospective cohort included hospitalized adults admitted from July 2015 to July 2017 treated with a β-lactam as definitive monotherapy against a gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): nonobese (BMI ≤29.9 kg/m(2)) and obese (BMI ≥30.0 kg/m(2)). The primary outcome was clinical treatment failure, and secondary outcomes were hospital length of stay, inpatient all-cause mortality, and 30-day all-cause readmission. RESULTS: There were 257 (43.6%) obese patients and 332 (56.4%) nonobese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by third-generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) nonobese patients (P < .001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than nonobese patients (P = .002), but no differences were found for all-cause mortality (P = .117) or infection-related readmission (0 = 0.112). CONCLUSIONS: Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients. Future studies are needed to assess the impact of therapeutic drug monitoring and specific dosing recommendations for targeted infection types. |
format | Online Article Text |
id | pubmed-8391092 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-83910922021-08-27 Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams Pinner, Nathan A Tapley, Natalie G Barber, Katie E Stover, Kayla R Wagner, Jamie L Open Forum Infect Dis Major Articles BACKGROUND: Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial. METHODS: This multicenter, retrospective cohort included hospitalized adults admitted from July 2015 to July 2017 treated with a β-lactam as definitive monotherapy against a gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): nonobese (BMI ≤29.9 kg/m(2)) and obese (BMI ≥30.0 kg/m(2)). The primary outcome was clinical treatment failure, and secondary outcomes were hospital length of stay, inpatient all-cause mortality, and 30-day all-cause readmission. RESULTS: There were 257 (43.6%) obese patients and 332 (56.4%) nonobese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by third-generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) nonobese patients (P < .001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than nonobese patients (P = .002), but no differences were found for all-cause mortality (P = .117) or infection-related readmission (0 = 0.112). CONCLUSIONS: Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients. Future studies are needed to assess the impact of therapeutic drug monitoring and specific dosing recommendations for targeted infection types. Oxford University Press 2021-04-27 /pmc/articles/PMC8391092/ /pubmed/34458387 http://dx.doi.org/10.1093/ofid/ofab212 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Major Articles Pinner, Nathan A Tapley, Natalie G Barber, Katie E Stover, Kayla R Wagner, Jamie L Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title | Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title_full | Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title_fullStr | Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title_full_unstemmed | Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title_short | Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams |
title_sort | effect of obesity on clinical failure of patients treated with β-lactams |
topic | Major Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391092/ https://www.ncbi.nlm.nih.gov/pubmed/34458387 http://dx.doi.org/10.1093/ofid/ofab212 |
work_keys_str_mv | AT pinnernathana effectofobesityonclinicalfailureofpatientstreatedwithblactams AT tapleynatalieg effectofobesityonclinicalfailureofpatientstreatedwithblactams AT barberkatiee effectofobesityonclinicalfailureofpatientstreatedwithblactams AT stoverkaylar effectofobesityonclinicalfailureofpatientstreatedwithblactams AT wagnerjamiel effectofobesityonclinicalfailureofpatientstreatedwithblactams |