Title Antibiotic therapy in septic patients treated with renal replacement and extracorporeal blood purification therapy Title (croatian) Antibiotsko liječenje u septičnih bolesnika kojima je primjenjena bubrežna nadomjesna terapija i terapija izvantjelesne purifikacije krvi Author Alisa Franceska Schelling Mentor Ivana Mudnić (mentor)Committee member Mladen Boban (predsjednik povjerenstva)Committee member Vedran Kovačić (član povjerenstva)Committee member Doris Rušić (član povjerenstva)Granter University of Split Defense date and country 2024-07-10, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Introduction: Sepsis accounts for one of the leading causes of death in critically ill patients in
the ICU. One of the most common and severe complications of sepsis is acute kidney injury.
Due to its high mortality, early recognition and treatment initiation is crucial to prevent severe
outcomes. Rational and rapid prescription of antibiotic therapy is essential in the treatment of
these patients.
Objectives: The main goal of this research was to determine the frequency and pattern of
... More use
of antimicrobial drugs and how the use of antimicrobial pharmacotherapy was associated with
the recovery rate and mortality rates on the 7th and 28th day of hospitalization and length of
hospitalization of patients with acute kidney injury who underwent renal replacement and blood
purification therapy.
Subjects and Methods: This is a retrospective cohort study using data from patients treated in
the intensive care unit at the Clinic for Anesthesiology, Reanimation, and Intensive Care in the
period from January 1, 2022, to December 31, 2023. Inclusion criteria were the diagnosis of
sepsis and a set indication for renal replacement therapy and exclusion criteria included death
within 48 hours of diagnosis of sepsis, ICU hospitalization more than 4 weeks (28 days),
significant chronic end-stage heart, kidney or liver disease, and insufficient data in the medical
records. The study included 49 patients out of 67 patients after applying of these criteria. Patient
data and characteristics were extracted from their medical records and data on
pharmacotherapy, renal replacement and blood purification therapy, clinical and laboratory
findings, microbiological isolates were collected, and the treatment outcomes were performed.
Results: Each subject was treated with an average of four different antibacterial drugs. A total
of 30 antibacterials, 5 antifungals and 2 antivirals were prescribed, with meropenem (73 %),
vancomycin (59 %) and metronidazole (49 %) being most commonly used ones. Younger
patients were treated with higher number of antibacterials (r = -0,442, P = 0,001) and those
treated with combination of piperacillin and tazobactam had higher probability of complete
recovery (P = 0,023). Intensive antibiotic therapy was associated with less 7th day mortality
rate (P = 0,009) and longer in-hospital stay (r = 0,494, and r = 0,503, for ICU and total
hospitalization days, respectively, P <0,001).
Conclusion: Although septic patients with acute kidney injury who underwent renal
replacement and blood purification therapy were treated with intensive antibiotic therapy that
included different antibiotics, only the use of a combination of piperacillin and tazobactam
increased the recovery rate. The use of antibiotic therapy generally had no effect on the longterm
mortality rate but was associated with lower short-term mortality and longer
hospitalization of these patients. Less Abstract (croatian) Ciljevi: Utvrditi učestalost i obrazac antimikrobne terapije te kako je ona povezana s ishodima
liječenja, oporavkom i stopom smrtnosti nakon sedam i 28 dana hospitalizacije te trajanjem
liječenja.
Ispitanici i metode: U povijesno kohortno istraživanje uključeni su bolesnici liječeni u Jedinici
intenzivnog liječenja Klinike za anesteziologiju, reanimaciju i intenzivno liječenje u razdoblju
od 1. siječnja 2022. do 31. prosinca 2023. Uključni kriteriji bili su dijagnoza sepse i
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bubrežna nadomjesna terapija, a isključni kriteriji uključivali su smrt unutar 48 sati od dijagnoze
sepse, hospitalizaciju u JILu liječenja duze od 4 tjedna (28 dana), značajnu kroničnu bolest srca,
bubrega ili jetre u završnom stadiju i nedostatne podatke u medicinskoj dokumentaciji. Nakon
primjene ovih kriterija, u istraživanje je uključeno 49 od 67 pacijenata. Provedeno je
prikupljanje podataka o farmakoterapiji, bubrežnoj nadomjesnoj terapiji, kliničkom statusu te
laboratorijskim nalazima, mikrobiološkim izolatima i ishodima liječenja iz medicinske
dokumentacije.
Rezultati: Svaki je ispitanik liječen u prosjeku s četiri različita antibakterijska lijeka. Propisano
je ukupno 30 antibakterijskih lijekova, pet antimikotika i dva antivirusna lijeka, a meropenem
(73 %), vankomicin (59 %) i metronidazol (49 %) bili su najčešće korišteni. Mlađi bolesnici
liječeni su većim brojem antibakterijskih lijekova (r = -0,442, P = 0,001), a oni liječeni
kombinacijom piperacilina i tazobaktama imali su veću vjerojatnost oporavka (P = 0,023).
Intenzivna antibiotska terapija bila je povezana s nižom stopom smrtnosti sedmog dana liječenja
(P = 0,009) i dužim boravkom u bolnici (r = 0,494, odnosno r = 0,503, za trajanje intenzivnog
liječenja i ukupni broj dana bolničkog liječenja, P <0,001).
Zaključak: Iako su septični bolesnici s akutnom bubrežnom ozljedom podvrgnuti nadomjesnoj
bubrežnoj funkciji i terapiji izvantjelesne purifikacije krvi liječeni intenzivnom antibiotskom
terapijom koja je uključivala različite antibiotike, samo je primjena kombinacije piperacilina i
tazobaktama povećala stopu oporavka. Primjena antibiotske terapije općenito nije imala
utjecaja na dugoročnu smrtnosti, ali je bila povezana s nižom kratkoročnom smrtnošću i duljom
hospitalizacijom ovih bolesnika. Less Keywords
Antibiotics
Sepsis
Acute Kidney Injury
Keywords (croatian)
antibiotici
sepsa
akutna ozljeda bubrega
Language english URN:NBN urn:nbn:hr:171:676200 Study programme Title: Medical Studies in English Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-07-08 11:31:58
