Clinical Outcomes of Cefepime Dosing in Patients With Pseudomonas aeruginosa Infections Undergoing Renal Replacement Therapies

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2025-02-18 DOI:10.1111/hdi.13204

Wasim S. El Nekidy, Khaled Alzaman, Emna Abidi, Muriel Ghosn, Khaled Ismail, Islam M. Ghazi, Rania El Lababidi, Mohamad Mooty, Amir Malik, Amna Alshamsi, Ali Almheiri, Jihad Mallat

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引用次数: 0

Abstract

Objective

Data regarding the efficacy of cefepime in treating patients with Pseudomonas aeruginosa infections undergoing renal replacement therapy (RRT) are limited. Therefore, we conducted a study to investigate the outcomes of recommended cefepime dosing in this population.

Methods

A retrospective descriptive cohort study was conducted between May 2015 and December 2022 on patients diagnosed with active sepsis secondary to P. aeruginosa infection, requiring cefepime treatment and undergoing RRT. The primary endpoint was 30-day all-cause mortality, with secondary endpoints including clinical cure, microbiologic cure, infection recurrence rate, and incidence of adverse events.

Results

A total of 132 patients met the inclusion criteria. Of these, 81 (62.4%) were male, with a median age of 69 years and a median BMI of 27 kg/m². The most common diagnoses were pneumonia (58.3%), followed by bacteremia (18.9%). The median minimum inhibitory concentration (MIC) of cefepime for P. aeruginosa was 2 mcg/mL. The median dose of cefepime was 2000 mg every 12 h in those undergoing continuous venovenous hemofiltration and 1000 mg every 24 h in those undergoing intermittent hemodialysis, with a median duration of therapy of 8 days. The median Charlson Comorbidity index for survivors was 9 (8–11), while it was 7.5 (5.25–9.75) for non-survivors (p = 0.754). The 30-day survival rate was achieved in 96 patients (72.7%), the clinical cure was achieved in 58.3% of subjects, and a microbiologic cure rate of 31%. The 30-day reinfection rate was 9.1%, with no documented adverse events associated with the doses used. Multivariable logistic regression analysis identified the use of vasopressors (Odds Ratio 4.6, 95% CI 1.3–17.1) and white blood cell count at the end of therapy (Odds Ratio 1.1, 95% CI 1.01–1.4) as the main predictors of all-cause mortality in this population.

Conclusion

Our results suggest that the utilized doses of cefepime in patients with P. aeruginosa infections undergoing RRT were effective. Larger study is needed to confirm our findings.

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接受肾脏替代疗法的铜绿假单胞菌感染患者使用头孢吡肟剂量的临床结果

目的：关于头孢吡肟治疗铜绿假单胞菌感染接受肾脏替代治疗（RRT）患者的疗效资料有限。因此，我们进行了一项研究，以调查在这一人群中推荐的头孢吡肟剂量的结果。方法：2015年5月至2022年12月，对诊断为铜绿假单胞菌感染继发活动性脓毒症、需要头孢吡肟治疗并接受RRT的患者进行回顾性描述性队列研究。主要终点是30天全因死亡率，次要终点包括临床治愈、微生物治愈、感染复发率和不良事件发生率。结果：132例患者符合纳入标准。其中，81例（62.4%）为男性，中位年龄为69岁，中位BMI为27 kg/m2。最常见的诊断是肺炎（58.3%），其次是菌血症（18.9%）。头孢吡肟对铜绿假单胞菌的最小抑制浓度（MIC）为2 mcg/mL。连续静脉-静脉血液滤过组头孢吡肟的中位剂量为2000 mg / 12 h，间歇血液透析组为1000 mg / 24 h，治疗中位持续时间为8天。幸存者的Charlson共病指数中位数为9(8-11)，而非幸存者的Charlson共病指数中位数为7.5 (5.25-9.75)（p = 0.754）。96例患者30天生存率为72.7%，临床治愈率为58.3%，微生物治愈率为31%。30天再感染率为9.1%，没有与使用剂量相关的不良事件记录。多变量logistic回归分析确定血管加压药物（优势比4.6,95% CI 1.3-17.1）和治疗结束时白细胞计数（优势比1.1,95% CI 1.01-1.4）的使用是该人群全因死亡率的主要预测因素。结论：我们的研究结果表明，铜绿假单胞菌感染患者接受RRT治疗时，头孢吡肟的使用剂量是有效的。需要更大规模的研究来证实我们的发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.