Abstract：
Background: Augmented renal clearance (ARC) is a phenomenon observed in critically ill patients, leading to supraphysiologic drug clearance and concern for suboptimal antibiotic concentrations. The purpose of this study was to compare the clinical outcomes of our institutional protocolized antibiotic dosing regimen in critically ill patients with bacteremia and ARC compared with critically ill patients without ARC. Patients and Methods: We performed a retrospective study comparing the efficacy of an institutional protocolized antibiotic dosing regimen in critically ill patients with bacteremia and ARC compared with critically ill patients without ARC. The primary end point was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, days requiring mechanical ventilation, ICU length of stay (LOS), hospital LOS, development of drug resistance to index antibiotic agent, and documented clearance of blood cultures within 72 hours. Results: There were 75 patients included in this study. Twenty percent of patients in the ARC group died in the hospital versus 31% in the non-ARC group (p = 0.26). The results for the ARC group versus the non-ARC group for the secondary outcomes of ICU mortality (20% vs. 26%; p = 0.56), ICU LOS (14.7 days vs. 7 days; p = 0.07), hospital LOS (28.3 days vs. 21.6 days; p = 0.03), days requiring mechanical ventilation (14 days vs. 12 days; p = 0.49), duration of antibiotic therapy (7.5 days vs. 9.0 days; p = 0.39), documented clearance of blood cultures within 72 hours (41% vs. 33%; p = 0.56), and the development of drug resistance to the index antibiotic agent (0% vs. 0%; p > 0.99) were also calculated. Conclusions: Among critically ill patients with bacteremia and ARC, there was no difference in in-hospital mortality compared with critically ill patients without ARC. There was a difference in hospital LOS, with a shorter duration of stay for the non-ARC group. There was no development of multi-drug-resistant organisms in either group.
摘要：
背景：增强肾清除（ARC）是在危重患者中观察到的一种现象，导致超生理药物清除和对次优抗生素浓度的关注。这项研究的目的是比较我们的机构原生质抗生素给药方案在有菌血症和ARC的危重患者与无ARC的危重患者中的临床结果。患者和方法：我们进行了一项回顾性研究，比较了在有菌血症和ARC的危重患者中，与没有ARC的危重患者相比，机构原生质抗生素给药方案的疗效。主要终点是院内死亡率。次要结果是重症监护病房（ICU）死亡率，需要机械通气的天数，ICU住院时间(LOS),医院LOS,对索引抗生素药物的耐药性的发展，并记录了72小时内血培养物的清除。结果：本研究共纳入75例患者。ARC组有20%的患者在医院死亡，而非ARC组有31%的患者死亡(p=0.26)。对于ICU死亡率的次要结局，ARC组与非ARC组的结果（20％vs.26%；p=0.56)，ICULOS（14.7天vs.7天；p=0.07），医院LOS（28.3天vs.21.6天；p=0.03)，需要机械通气的天数(14天vs.12天；p=0.49），抗生素治疗的持续时间(7.5天vs.9.0天；p=0.39)，记录72小时内血培养清除率(41%vs.33%；p=0.56)，以及对指标抗生素药物耐药性的发展(0%vs.0%；p>0.99)也被计算。结论：在有菌血症和ARC的危重患者中，与无ARC的危重患者相比,院内死亡率无差异.医院的LOS有所不同，非ARC组的停留时间较短。两组中都没有发展出耐多药的生物。
