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Clinical Trial
. 2024 Feb 1;11(3):ofae059.
doi: 10.1093/ofid/ofae059. eCollection 2024 Mar.

Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study

Namareq F Aldardeer  1 , Maram M Alshreef  2 , Emad A Alharbi  3 , Ahmad K Aljabri  3 , Mohammad H Aljawadi  4 , Thamer A Almangour  4 , Saad Alobaili  5 , Mohammed I Alarifi  6 , Awad Alomari  7 , Abdullah M Alhammad  4   8
Affiliations
Clinical Trial

Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study

Namareq F Aldardeer et al. Open Forum Infect Dis. .

Abstract

Background: Acute kidney injury (AKI) is a common complication of sepsis, contributing to an increased mortality rate. However, some studies have demonstrated that renal function improves in sepsis patients with AKI within 48 hours, raising questions about the necessity for early antibiotic adjustment. This study evaluates the association between the timing of antipseudomonal β-lactam dose adjustment and the outcomes of critically ill sepsis patients with AKI.

Methods: A prospective, multicenter observational study of critically ill patients aged ≥18 years admitted to the intensive care unit with sepsis and AKI and started on antipseudomonal β-lactam therapy. After the initial dose, eligible patients were grouped as early β-lactam antibiotic (E-BLA) or late β-lactam antibiotic (L-BLA) dose adjustments based on the administration of subsequent renally adjusted doses within 24 hours and after 24 hours of sepsis recognition, respectively. The main outcome of interest was in-hospital mortality.

Results: Among 1185 patients screened, 224 (mean age, 62.7 ± 16.8 years; 62% were male) met inclusion criteria. Eighty-four and 140 patients were included in the E-BLA and L-BLA groups, respectively. Approximately half of the cohort presented with AKI stage II, and piperacillin-tazobactam was prescribed as initial empirical therapy in more than 50% of the cohort. In the multivariable Cox proportional hazards model, L-BLA was associated with a significant reduction in in-hospital mortality compared to E-BLA (hazard ratio, 0.588 [95% confidence interval, .355-.974]).

Conclusions: In sepsis patients with AKI, L-BLA was associated with in-hospital mortality benefits.

Keywords: acute kidney injury; intensive care unit; sepsis; septic shock; β-lactams.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts.

Figures

Figure 1.
Figure 1.
Flow diagram of patient screening. Abbreviations: COVID-19, coronavirus disease 2019; ESRD, end-stage renal disease; HD, hemodialysis; ICU, intensive care unit; RRT, renal replacement therapy.
Figure 2.
Figure 2.
Kaplan-Meier survival analysis curve for in-hospital mortality in critically ill patients with sepsis and acute kidney injury based on the timing of dose adjustment.
See this image and copyright information in PMC

References

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