Pulse High-Volume Hemofiltration in Management of Critically Ill Patients with Severe Sepsis or Septic Shock

ABSTRACTPathophysiological changes during the early phase of severe sepsis and septic shock in critically ill patients, resulting in altered pharmacokinetic (PK) patterns for antibiotics, are important factors influencing therapeutic success. The aims of this study were (i) to reveal the population PK parameters and (ii) to assess the probability of target attainment (PTA) for meropenem. The PK studies were carried out following administration of 1 g of meropenem every 8 h during the first 24 h of severe sepsis and septic shock in nine patients, and a Monte Carlo simulation was performed to determine the PTA of achieving 40% exposure time during which the free plasma drug concentration remains above the MIC (fT>MIC) and 80%fT>MIC. The volume of distribution (V) and total clearance (CL) of meropenem in these patients were 23.7 liters and 7.82 liters/h, respectively. For pathogens with MICs of 4 μg/ml, the PTAs of 40%fT>MICfollowing administration of meropenem as a 1-h infusion of 1 g every 8 h and a 4-h infusion of 0.5 g every 8 h were 92.52% and 90.29%, respectively. For pathogens with MICs of 2 μg/ml in immunocompromised hosts, the PTAs of 80%fT>MICfollowing administration of 1-h and 4-h infusions of 2 g of meropenem every 8 h were 84.32% and 94.72%, respectively. These findings indicated that theVof meropenem was greater and the CL of meropenem was lower than the values obtained in a previous study with healthy subjects. The maximum recommended dose, i.e., 2 g of meropenem every 8 h, may be required for treatment of life-threatening infections in this patient population.

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Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

10.21203/rs.3.rs-17042/v1 ◽

2020 ◽

Author(s):

Viveka Björck ◽

Lisa I Påhlman ◽

Mikael Bodelsson ◽

Ann_Cathrine Petersson ◽

Thomas Kander

Keyword(s):

Septic Shock ◽

Renal Failure ◽

Severe Sepsis ◽

Intensive Care ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Saps 3 ◽

Group A ◽

Lower Mortality Risk

Abstract Background Group A streptococci (GAS) are known to cause serious invasive infections but little is known about outcomes when patients with these infections are admitted to intensive care. We wanted to describe critically ill patients with severe sepsis or septic shock due to invasive GAS (iGAS) and compare them with other patients with severe sepsis or septic shock. Methods Adult patients admitted to a general intensive care unit (ICU) in Sweden (2007-2019) were screened for severe sepsis or septic shock according to Sepsis 2 definition. Individuals with iGAS infection were identified. The outcome variables were mortality, days alive and free of vasopressors and invasive mechanical ventilation, maximum acute kidney injury score for creatinine, use of continuous renal replacement therapy and maximum sequential organ failure assessment score during the ICU stay. Age, simplified acute physiology score (SAPS 3) and iGAS were used as independent, explanatory variables in regression analysis. Cox regression was used for survival analyses. Results iGAS was identified in 53 of 1021 (5.2%) patients. Patients with iGAS presented lower median SAPS 3 score (62 [56–72]) vs 71 [61–81]), p < 0.001), had a higher frequency of cardiovascular cause of admission to the ICU (38 [72%] vs 145 [15%], p < 0.001) and had a higher median creatinine score (173 [100–311] vs 133 [86–208] µmol/L, p < 0.019). Of the GAS isolates, 50% were serotyped emm 1/T1 and this group showed signs of more pronounced circulatory and renal failure than patients with non- emm 1/T1, ( p = 0.036 and p = 0.007, respectively). After correction for severity of illness (SAPS 3) and age, iGAS infection was associated with lower mortality risk; 95% confidence interval (CI) of hazard ratio (HR) 0.204–0.746, p < 0.001. Morbidity analyses demonstrated that iGAS patients were more likely to develop renal failure. Conclusion Critically ill patients with iGAS infection had a lower mortality risk but a higher degree of renal failure compared to similarly ill sepsis patients. emm 1/T1 was found to be the most dominant serotype and patients with emm1 /T1 demonstrated more circulatory and renal failure than patients with other serotypes of iGAS.

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