Augmented renal clearance is not a risk factor for mortality in Enterobacteriaceae bloodstream infections treated with appropriate empiric antimicrobials

PLoS One. 2017 Jul 5;12(7):e0180247. doi: 10.1371/journal.pone.0180247. eCollection 2017.

Abstract

The main objective of the study was to assess whether augmented renal clearance was a risk factor for mortality in a cohort of patients with Enterobacteriaceae sepsis, severe sepsis, or septic shock that all received appropriate antimicrobial therapy within 12 hours. Using a retrospective cohort from Barnes-Jewish Hospital, a 1,250-bed teaching hospital, we collected data on individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013. Clinical outcomes were compared according to renal clearance, as assessed by Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, sepsis classification, demographics, severity of illness, and comorbidities. We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Augmented renal clearance was uncommon (5.1% of patients by MDRD and 3.0% by CKD-EPI) and was not associated with increased mortality. Our results are limited by the absence of prospective determination of augmented renal clearance. However, in this small cohort, augmented renal clearance as assessed by MDRD and CKD-EPI does not seem to be a risk factor for mortality in patients with Enterobacteriaceae sepsis. Future studies should assess this finding prospectively.

MeSH terms

  • Adult
  • Anti-Infective Agents / therapeutic use*
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / physiology
  • Enterobacteriaceae Infections / complications
  • Enterobacteriaceae Infections / drug therapy*
  • Enterobacteriaceae Infections / microbiology
  • Female
  • Glomerular Filtration Rate
  • Hospital Mortality
  • Host-Pathogen Interactions / drug effects
  • Humans
  • Kidney / metabolism
  • Kidney / pathology
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / metabolism*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Sepsis / drug therapy
  • Sepsis / microbiology
  • Sepsis / mortality
  • Shock, Septic / drug therapy
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Young Adult

Substances

  • Anti-Infective Agents

Grants and funding

Dr. Burnham reports that the research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.