Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams.
Effect of Obesity on Clinical Failure of Patients Treated With β-Lactams.
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DOI：
10.1093/ofid/ofab212
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发表时间：
2021-08
影响因子：
4.2
通讯作者：
Wagner JL
中科院分区：
文献类型：
--
作者：
Pinner NA;Tapley NG;Barber KE;Stover KR;Wagner JL
肥胖患者的药代动力学改变引起了对更差临床结局的担忧。本研究评估了与非肥胖患者相比，接受β-内酰胺类药物治疗的肥胖患者的临床结局是否更差，并确定治疗药物监测是否有益。该多中心、回顾性队列纳入了2015年7月至2017年7月期间入院接受β-内酰胺作为革兰氏阴性杆菌确定性单药治疗≥72小时的住院成人。如果缺乏源控制或如果多微生物感染需要>1种抗生素进行确定性治疗，则排除患者。根据体重指数（BMI）对患者进行分类：非肥胖（BMI ≤29.9 kg/m2）和肥胖（BMI ≥30.0 kg/m2）。 主要结局为临床治疗失败，次要结局为住院时间、住院患者全因死亡率和30天全因再入院率。肥胖患者257例（43.6%），非肥胖患者332例（56.4%）。最常见的感染是泌尿道感染（50.9%）和呼吸道感染（31.4%）。第三代头孢菌素（46.9%）和头孢吡肟（44.7%）是持续治疗的驱动因素。131例（51%）肥胖患者和109例（32.8%）非肥胖患者发生治疗失败（P <0.001）。 肥胖和呼吸源与治疗失败的可能性增加独立相关。肥胖患者住院时间长于非肥胖患者（P = 0.002），但全因死亡率（P = 0.117）或感染相关再入院率（0 = 0.112）无差异。 与非肥胖患者相比，接受β-内酰胺类药物治疗的肥胖患者有更高的治疗失败率和更长的住院时间。需要未来的研究来评估治疗药物监测和针对目标感染类型的具体给药建议的影响。肥胖患者的药代动力学改变引起了对更差临床结局的担忧。在这项研究中，与非肥胖患者相比，接受β-内酰胺类药物治疗的肥胖患者有更高的治疗失败率和更长的住院时间。
Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a β-lactam have worse clinical outcomes compared to nonobese patients and to identify if therapeutic drug monitoring may be beneficial. This multicenter, retrospective cohort included hospitalized adults admitted from July 2015 to July 2017 treated with a β-lactam as definitive monotherapy against a gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): nonobese (BMI ≤29.9 kg/m2) and obese (BMI ≥30.0 kg/m2). The primary outcome was clinical treatment failure, and secondary outcomes were hospital length of stay, inpatient all-cause mortality, and 30-day all-cause readmission. There were 257 (43.6%) obese patients and 332 (56.4%) nonobese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by third-generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) nonobese patients (P < .001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than nonobese patients (P = .002), but no differences were found for all-cause mortality (P = .117) or infection-related readmission (0 = 0.112). Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients. Future studies are needed to assess the impact of therapeutic drug monitoring and specific dosing recommendations for targeted infection types. Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. In this study, obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than nonobese patients.
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DOI：
10.1183/09031936.00185211
发表时间：
2013-04
期刊：
The European respiratory journal
影响因子：
--
作者：
King P;Mortensen EM;Bollinger M;Restrepo MI;Copeland LA;Pugh MJ;Nakashima B;Anzueto A;Hitchcock Noël P
通讯作者：
Hitchcock Noël P
影响因子：
4.1
作者：
Meng, Lina;Mui, Emily;Deresinski, Stan C.
通讯作者：
Deresinski, Stan C.
影响因子：
2
作者：
Bratzler, Dale W.;Dellinger, E. Patchen;Weinstein, Robert A.
通讯作者：
Weinstein, Robert A.
影响因子：
11.8
作者：
Lodise, Thomas P., Jr.;Lomaestro, Ben;Drusano, George L.
通讯作者：
Drusano, George L.
影响因子：
120.7
作者：
Mokdad, AH;Ford, ES;Marks, JS
通讯作者：
Marks, JS