Aminoglycosides in Immunocompromised Critically Ill Patients With Bacterial Pneumonia and Septic Shock: A Post-Hoc Analysis of a Prospective Multicenter Multinational Cohort
René Lopez
(1, 2)
,
Jordi Rello
(3, 4, 5)
,
Fabio Silvio Taccone
(6)
,
Omar Ben Hadj Salem
(7)
,
Philippe Bauer
(8)
,
Amélie Séguin
(9)
,
Andry van de Louw
(10)
,
Victoria Metaxa
(11)
,
Kada Klouche
(12)
,
Ignacio Martin Loeches
(13)
,
Luca Montini
(14)
,
Sangeeta Mehta
(15)
,
Fabrice Bruneel
(16)
,
T. Lisboa
(17)
,
William Viana
(18)
,
Peter Pickkers
(19)
,
Lene Russell
(20)
,
Katerina Rusinova
(21)
,
Achille Kouatchet
(22)
,
François Barbier
(23)
,
Djamel Mokart
(24)
,
Elie Azoulay
(1, 2)
,
Michael Darmon
(1, 2)
1
SBIM -
Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA)
2 ECSTRRA [CRESS - U1153 / UMR_A 1125] - Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation | Epidémiologie Clinique, STatistique, pour la Recherche en Santé
3 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
4 VHIR - Vall d’Hebron Research Institute
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 ULB - Hôpital Erasme [Bruxelles]
7 Hôpital Cochin [AP-HP]
8 Mayo Clinic [Rochester]
9 Service des Urgences [CHU Nantes]
10 Penn State - Pennsylvania State University
11 KCH - King's College Hospital
12 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
13 Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St James Street, Dublin 8, Dublin, Ireland.
14 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
15 Lunenfeld-Tanenbaum Research Institute [Toronto, Canada]
16 CHV - Centre Hospitalier de Versailles André Mignot
17 Santa Casa de Misericórdia de Porto Alegre
18 Emergencia Adultos Rede D'Or Hospital Copa
19 Radboud University Medical Center [Nijmegen]
20 Department of Intensive Care [Rigshospitalet]
21 Medicine Charles University and General Faculty Hospital in Prague
22 CHU Angers - Centre Hospitalier Universitaire d'Angers
23 CHRO - Centre Hospitalier Régional d'Orléans
24 IPC - Institut Paoli-Calmettes
2 ECSTRRA [CRESS - U1153 / UMR_A 1125] - Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation | Epidémiologie Clinique, STatistique, pour la Recherche en Santé
3 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
4 VHIR - Vall d’Hebron Research Institute
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 ULB - Hôpital Erasme [Bruxelles]
7 Hôpital Cochin [AP-HP]
8 Mayo Clinic [Rochester]
9 Service des Urgences [CHU Nantes]
10 Penn State - Pennsylvania State University
11 KCH - King's College Hospital
12 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
13 Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St James Street, Dublin 8, Dublin, Ireland.
14 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
15 Lunenfeld-Tanenbaum Research Institute [Toronto, Canada]
16 CHV - Centre Hospitalier de Versailles André Mignot
17 Santa Casa de Misericórdia de Porto Alegre
18 Emergencia Adultos Rede D'Or Hospital Copa
19 Radboud University Medical Center [Nijmegen]
20 Department of Intensive Care [Rigshospitalet]
21 Medicine Charles University and General Faculty Hospital in Prague
22 CHU Angers - Centre Hospitalier Universitaire d'Angers
23 CHRO - Centre Hospitalier Régional d'Orléans
24 IPC - Institut Paoli-Calmettes
Jordi Rello
- Fonction : Auteur
- PersonId : 764005
- ORCID : 0000-0003-0676-6210
Kada Klouche
- Fonction : Auteur
- PersonId : 930999
- ORCID : 0000-0003-1633-7700
Elie Azoulay
- Fonction : Auteur
- PersonId : 1189025
- ORCID : 0000-0002-8162-1508
- IdRef : 066920515
Michael Darmon
- Fonction : Auteur
- PersonId : 910815
- ORCID : 0000-0003-4198-8038
- IdRef : 069528896
Résumé
The routine use of empiric combination therapy with aminoglycosides during critical illness is associated with uncertain benefit and increased risk of acute kidney injury. This study aimed to assess the benefits of aminoglycosides in immunocompromised patients with suspected bacterial pneumonia and sepsis.
Methods: Secondary analysis of a prospective multicenter study. Adult immunocompromised patients with suspected bacterial pneumonia and sepsis or septic shock were included. Primary outcome was hospital mortality. Secondary outcomes were needed for renal replacement therapy (RRT). Mortality was also assessed in neutropenic patients and in those with confirmed bacterial pneumonia. Results were further analyzed in a cohort matched on risk of receiving aminoglycosides combination.
Results: Five hundred thirty-five patients were included in this analysis, of whom 187 (35%) received aminoglycosides in addition to another antibiotic effective against gram-negative bacteria. Overall hospital mortality was 59.6% (58.3% vs. 60.3% in patients receiving and not receiving combination therapy; P = 0.71). Lack of association between mortality and aminoglycosides was confirmed after adjustment for confounders and center effect (adjusted OR 1.14 [0.69-1.89]) and in a propensity matched cohort (adjusted OR = 0.89 [0.49-1.61]). No association was found between aminoglycosides and need for RRT (adjusted OR = 0.83 [0.49-1.39], P = 0.477), nor between aminoglycoside use and outcome in neutropenic patients or in patients with confirmed bacterial pneumonia (adjusted OR 0.66 [0.23-1.85] and 1.25 [0.61-2.57], respectively).
Conclusion: Aminoglycoside combination therapy was not associated with hospital mortality or need for renal replacement therapy in immunocompromised patients with pulmonary sepsis.