Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study
Septic shock substantially alters the pharmacokinetic properties of β-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of β-lactams extend the time that...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/10/6/687 |
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| author | Daniel Christoph Richter Maximilian Dietrich Lazar Detelinov Lalev Felix C. F. Schmitt Mascha Onida Fiedler Thomas Bruckner Dominic Stoerzinger Ute Chiriac Sabrina Klein Thilo Hackert Thorsten Brenner Alexander Brinkmann Markus A. Weigand |
| author_facet | Daniel Christoph Richter Maximilian Dietrich Lazar Detelinov Lalev Felix C. F. Schmitt Mascha Onida Fiedler Thomas Bruckner Dominic Stoerzinger Ute Chiriac Sabrina Klein Thilo Hackert Thorsten Brenner Alexander Brinkmann Markus A. Weigand |
| author_sort | Daniel Christoph Richter |
| collection | DOAJ |
| description | Septic shock substantially alters the pharmacokinetic properties of β-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of β-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (<i>f</i>t <sub>>MIC</sub>) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with β-lactams. Patients of the years 2015–2017 received intermittent bolus application whereas patients of 2017–2020 received PI of β-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, <i>n</i> = 119/290 vs. IB: 54.8%, <i>n</i> = 68/114; <i>p</i> = 0.0097) and day 90 (PI: 47.9%, <i>n</i> = 139/290 vs. IB: 62.9%, <i>n</i> = 78/124; <i>p</i> = 0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (−10%, <i>p</i> = 0.14). PI was further associated with a reduction in the duration of invasive ventilation and a stronger decrease in SOFA scores within a 14 day-observation period. PI of β-lactams was associated with a significant reduction of mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure. |
| first_indexed | 2024-03-10T10:36:28Z |
| format | Article |
| id | doaj.art-cf22c2048ac2485f97966695e1d9134f |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T10:36:28Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-cf22c2048ac2485f97966695e1d9134f2023-11-21T23:16:13ZengMDPI AGAntibiotics2079-63822021-06-0110668710.3390/antibiotics10060687Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after StudyDaniel Christoph Richter0Maximilian Dietrich1Lazar Detelinov Lalev2Felix C. F. Schmitt3Mascha Onida Fiedler4Thomas Bruckner5Dominic Stoerzinger6Ute Chiriac7Sabrina Klein8Thilo Hackert9Thorsten Brenner10Alexander Brinkmann11Markus A. Weigand12Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyInstitute of Medical Biometry & Biostatistics, Im Neuenheimer Feld 130.3, 69120 Heidelberg, GermanyDepartment of Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, GermanyDepartment of Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, GermanyDepartment of Infectious Diseases, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, GermanyDepartment of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, GermanyDepartment of Anesthesiology, Heidenheim Hospital, Schloßhaustraße 100, 89522 Heidenheim, GermanyDepartment of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, GermanySeptic shock substantially alters the pharmacokinetic properties of β-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of β-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (<i>f</i>t <sub>>MIC</sub>) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with β-lactams. Patients of the years 2015–2017 received intermittent bolus application whereas patients of 2017–2020 received PI of β-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, <i>n</i> = 119/290 vs. IB: 54.8%, <i>n</i> = 68/114; <i>p</i> = 0.0097) and day 90 (PI: 47.9%, <i>n</i> = 139/290 vs. IB: 62.9%, <i>n</i> = 78/124; <i>p</i> = 0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (−10%, <i>p</i> = 0.14). PI was further associated with a reduction in the duration of invasive ventilation and a stronger decrease in SOFA scores within a 14 day-observation period. PI of β-lactams was associated with a significant reduction of mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure.https://www.mdpi.com/2079-6382/10/6/687prolonged infusionβ-lactamsseptic shockmortalityantibiotic therapycritical care |
| spellingShingle | Daniel Christoph Richter Maximilian Dietrich Lazar Detelinov Lalev Felix C. F. Schmitt Mascha Onida Fiedler Thomas Bruckner Dominic Stoerzinger Ute Chiriac Sabrina Klein Thilo Hackert Thorsten Brenner Alexander Brinkmann Markus A. Weigand Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study Antibiotics prolonged infusion β-lactams septic shock mortality antibiotic therapy critical care |
| title | Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study |
| title_full | Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study |
| title_fullStr | Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study |
| title_full_unstemmed | Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study |
| title_short | Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study |
| title_sort | prolonged infusion of β lactams decreases mortality in patients with septic shock a retrospective before and after study |
| topic | prolonged infusion β-lactams septic shock mortality antibiotic therapy critical care |
| url | https://www.mdpi.com/2079-6382/10/6/687 |
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