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Aminoglycosides in Immunocompromised Critically Ill Patients With Bacterial Pneumonia and Septic Shock: A Post-Hoc Analysis of a Prospective Multicenter Multinational Cohort
R. Lopez, J. Rello, FS. Taccone, OBH. Salem, PR. Bauer, A. Séguin, A. van de Louw, V. Metaxa, K. Klouche, I. Martin Loeches, L. Montini, S. Mehta, F. Bruneel, T. Lisboa, W. Viana, P. Pickkers, L. Russell, K. Rusinova, A. Kouatchet, F. Barbier, D....
Language English Country United States
Document type Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- MeSH
- Aminoglycosides administration & dosage MeSH
- Anti-Bacterial Agents administration & dosage MeSH
- Pneumonia, Bacterial * complications drug therapy mortality MeSH
- Immunocompromised Host * MeSH
- Critical Illness MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Disease-Free Survival MeSH
- Prospective Studies MeSH
- Aged MeSH
- Shock, Septic * complications drug therapy mortality MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: The routine use of empiric combination therapy with aminoglycosides during critical illness is associated with uncertain benefit and increased risk of acute kidney injury. This study aimed to assess the benefits of aminoglycosides in immunocompromised patients with suspected bacterial pneumonia and sepsis. METHODS: Secondary analysis of a prospective multicenter study. Adult immunocompromised patients with suspected bacterial pneumonia and sepsis or septic shock were included. Primary outcome was hospital mortality. Secondary outcomes were needed for renal replacement therapy (RRT). Mortality was also assessed in neutropenic patients and in those with confirmed bacterial pneumonia. Results were further analyzed in a cohort matched on risk of receiving aminoglycosides combination. RESULTS: Five hundred thirty-five patients were included in this analysis, of whom 187 (35%) received aminoglycosides in addition to another antibiotic effective against gram-negative bacteria. Overall hospital mortality was 59.6% (58.3% vs. 60.3% in patients receiving and not receiving combination therapy; P = 0.71). Lack of association between mortality and aminoglycosides was confirmed after adjustment for confounders and center effect (adjusted OR 1.14 [0.69-1.89]) and in a propensity matched cohort (adjusted OR = 0.89 [0.49-1.61]). No association was found between aminoglycosides and need for RRT (adjusted OR = 0.83 [0.49-1.39], P = 0.477), nor between aminoglycoside use and outcome in neutropenic patients or in patients with confirmed bacterial pneumonia (adjusted OR 0.66 [0.23-1.85] and 1.25 [0.61-2.57], respectively). CONCLUSION: Aminoglycoside combination therapy was not associated with hospital mortality or need for renal replacement therapy in immunocompromised patients with pulmonary sepsis.
Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy
Anesthesiology Department CHU Nîmes University of Nîmes Montpellier Nîmes France
Department of Critical Care King's College Hospital NHS Foundation Trust London UK
Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
Department of Intensive Care Hospital Copa d'Or Rio de Janeiro Brazil
Department of Intensive Care Hospital Santa Rita Santa Casa de Misericordia Porte Allegre Brazil
Department of Medical Intensive Care Medicine University Hospital of Angers Angers France
Infectious Area Vall d'Hebron Institute of Research Barcelona Spain
Medical ICU Nantes University Hospital Nantes France
Medical Intensive Care Unit APHP Hôpital Cochin and University Paris Descartes Paris France
Medical Intensive Care Unit La Source Hospital CHR Orléans Orléans France
Medical Intensive Care Unit Montpellier University Hospital Montpellier France
Medical Surgical ICU Paoli Calmette Institute Marseille France
Medical Surgical Intensive Care Unit Andre Mignot Hospital Versailles France
Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota
The Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
References provided by Crossref.org
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