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Association between increased mortality rate and antibiotic dose adjustment in intensive care unit patients with renal impairment

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

Adjusting the antibiotic dose based on an estimation of the glomerular filtration rate (eGFR) may result in subdosing, which may actually be significantly more problematic for intensive care unit (ICU) patients than not adjusting the dose. The aim of this study was to assess the outcomes of antibiotic dose adjustment in ICU patients with renal impairment.

Methods

A retrospective cohort study was conducted in adult patients admitted to an ICU of a Brazilian hospital from January 2014 to December 2015. The eGFR was determined using Cockcroft–Gault and Modified Diet in Renal Disease equations for each day of hospitalization. Treatment failure was defined based on the clinical, laboratory, and radiological criteria.

Results

A total of 126 patients were assessed to meet the inclusion criteria and subsequently enrolled in the study (19.9% of patients admitted to the ICU during the study period). Of the 168 opportunities for dose adjustment, 99 (58.9%) adjustments were made. The mean eGFR in the group with dose adjustment was lower than that in the group without dose adjustment (38.5 vs. 40.7 mL/min/1.73 m2, respectively). The treatment failure rate among patients with dose adjustment and those treated with the usual dose was 59.3 and 38.9%, respectively (p = 0.023), and the mortality rates in the respective groups were 74.1 and 55.5% (p = 0.033). An association between dose adjustment and treatment failure/mortality rates was also observed in the multivariate analysis including the prognostic score.

Conclusions

In ICU patients with renal impairment, adjustments in antibiotic dose based on eGFR, significantly increased the risk of treatment failure and death.

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Funding

No funding was received.

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Authors and Affiliations

  1. Post-Graduate Program in Medicine and Health, Federal University of Bahia, Rua Padre Feijó, S/N, Canela, Salvador, Bahia, Brazil

    Marianne Silveira Camargo & Luiz Carlos Santana Passos

  2. Rua Rio de Contas, n. 350, Candeias, Vitória da Conquista, 45029-094, Bahia, Brazil

    Marianne Silveira Camargo

  3. Post-Graduate Program in Public Health, Multidisciplinary Institute of Health, Federal University of Bahia, Rua Rio de Contas, 58, Vitória da Conquista, Bahia, Brazil

    Sóstenes Mistro & Márcio Galvão Oliveira

Authors
  1. Marianne Silveira Camargo
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  2. Sóstenes Mistro
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  3. Márcio Galvão Oliveira
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  4. Luiz Carlos Santana Passos
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Contributions

MS Camargo was responsible for the study design, data analysis, and manuscript writing. S Mistro and MG Oliveira were responsible for the manuscript writing and data analysis. LC Passos supervised the study and was responsible for writing the manuscript.

Corresponding author

Correspondence to Marianne Silveira Camargo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. The study was approved by the Research Ethics Committee at Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil, with number (CAAE): 52721616.6.0000.5556.

Datasets

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Camargo, M.S., Mistro, S., Oliveira, M.G. et al. Association between increased mortality rate and antibiotic dose adjustment in intensive care unit patients with renal impairment. Eur J Clin Pharmacol 75, 119–126 (2019). https://doi.org/10.1007/s00228-018-2565-7

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  • DOI: https://doi.org/10.1007/s00228-018-2565-7

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