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外文期刊>Journal of Intensive Care
>The higher the better? Defining the optimal beta-lactam target for critically ill patients to reach infection resolution and improve outcome
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The higher the better? Defining the optimal beta-lactam target for critically ill patients to reach infection resolution and improve outcome
Abstract Objectives Beta-lactam antibiotics are often subject to therapeutic drug monitoring, but breakpoints of target attainment are mostly based on expert opinions. Studies that show a correlation between target attainment and infection resolution are missing. This analysis investigated whether there is a difference in infection resolution based on two breakpoints of target attainment. Methods An outcome group out of 1392 critically ill patients treated with meropenem or piperacillin-tazobactam was formed due to different selection criteria. Afterwards, three groups were created: group 1=free drug concentration ( f ) was MIC ), group 2=100% fT MIC 4xMIC . Parameters for infection control, renal and liver function, and estimated and observed in-hospital mortality were compared between those groups. Statistical analysis was performed with one-way analysis of variance, Tukey post hoc test, U test, and bivariate logistic regression. Results The outcome group consisted of 55 patients (groups 1–3, 17, 24, and 14 patients, respectively). Patients allocated to group 2 or 3 had a significantly faster reduction of the C-reactive protein in contrast to patients allocated to group 1 ( p = 0.033 and p = 0.026) . Patients allocated to group 3 had a worse renal function, a higher Acute Physiology and Chronic Health Evaluation (APACHE II) score, were older, and had a significantly higher in-hospital mortality compared to group 1 ( p = 0.017) and group 2 ( p = 0.001). The higher mortality was significantly influenced by worse liver function, higher APACHE II, and higher Sequential Organ Failure Assessment (SOFA) score and norepinephrine therapy. Conclusion Achieving the target 100% fT MIC leads to faster infection resolution in the critically ill. However, there was no benefit for patients who reached the highest target of 100% fT 4xMIC , although the mortality rate was higher possibly due to confounding effects. In conclusion, we recommend the target 100% fT MIC 4xMIC for critically ill patients.
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机译：摘要目的β-内酰胺抗生素通常受到治疗药物监测，但目标达到的断点主要是基于专家意见。缺少了目标达到和感染分辨率之间的相关性的研究。该分析研究了基于目标达到的两个断点是否存在感染分辨率的差异。方法由于不同的选择标准，形成了用梅洛克西姆或哌啶-Tazobactam治疗的1392名批判性患者的结果组。然后，创建三组：第1组=游离药物浓度（F）是MIC），第2组= 100％Ft> MIC 4xmic。在这些组之间比较了感染控制，肾病和肝功能的参数，估计和观察到的内外死亡率。通过单向分析进行统计分析，Tukey Hoc测试，U测试和双变量物流回归进行。结果结果组分别组成，分别由55例（分别为1-3,1-3,17,24和14名患者）组成。分配给第2组或3组的患者与分配给第1组的患者相比，C反应蛋白的显着减少（P = 0.033和P = 0.026）。分配给第3组的患者肾功能较差，急性生理学和慢性健康评估（Apache II）评分，年龄较大，与第1组（P = 0.017）和第2组相比具有显着高的内部死亡率（ p = 0.001）。肝功能较差，高脂肪II和更高的顺序器官衰竭评估（沙发）评分和去甲肾上腺素治疗，较高的死亡率受到严重影响。结论达到目标100％FT> MIC导致危重病中的感染速度更快。然而，对于达到100％FT> 4xmic的最高目标的患者没有任何益处，尽管由于混淆效应可能性率较高。总之，我们推荐目标100％ft>麦克风<4xmic用于批评患者。
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