Antibiotic treatment with one single dose of gentamicin at admittance in addition to a β-lactam antibiotic in the treatment of community-acquired bloodstream infection with sepsis

Prytz, Karolina Liljedahl; Prag, Mårten; Fredlund, Hans; Magnuson, Anders; Sundqvist, Martin; Källman, Jan

doi:10.1371/journal.pone.0236864

Cited by 14 publications

(10 citation statements)

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“…Sepsis is usually triggered by dysregulation of the organism's response to infection and is an acute organ dysfunction resulting from an abnormal immune response of the host to infection ( 17 ). Some clinical studies ( 18 ) have shown that among the various types of infections that cause sepsis, bloodstream infection is the most important factor in the death of patients with sepsis. And with the gradual increase in the incidence of sepsis after bloodstream infection in China in recent years, the research on the condition, prognosis assessment and prevention and treatment of sepsis caused by bloodstream infection has become a hot spot of concern for clinical workers.…”

Section: Discussionmentioning

confidence: 99%

Value of CRP, PCT, and NLR in Prediction of Severity and Prognosis of Patients With Bloodstream Infections and Sepsis

Liang

2022

Front. Surg.

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ObjectiveTo investigate the value of C-reactive protein (CRP), procalcitonin (PCT), and neutrophil to lymphocyte ratio (NLR) in assessing the severity of disease in patients with bloodstream infection and sepsis, and to analyze the relationship between the levels of three inflammatory factors and the prognosis of patients.MethodsThe clinical data of 146 patients with bloodstream infection and sepsis admitted to our intensive care unit (ICU) from October 2016 to May 2020 were retrospectively analyzed. The differences in the levels of inflammatory indicators such as CRP, PCT, and NLR within 24 h in patients with bloodstream infection sepsis with different conditions (critical group, non-critical group) and the correlation between these factors and the condition (acute physiology and chronic health evaluation II, APACHE II score) were analyzed. In addition, the prognosis of all patients within 28 days was counted, and the patients were divided into death and survival groups according to their mortality, and the risk factors affecting their death were analyzed by logistic regression, and the receiver operating characteristic (ROC) curve was used to analyze the value of the relevant indicators in assessing the prognosis of patients.ResultsThe levels of NLR, CRP, PCT, total bilirubin (TBIL), glutamic oxaloacetic transaminase (AST), and serum creatinine (Scr) were significantly higher in the critically ill group than in the non-critically ill group, where correlation analysis revealed a positive correlation between CRP, PCT, and NLR and APACHE II scores (P < 0.05). Univariate logistic regression analysis revealed that CRP, PCT, NLR, and APACHE II scores were associated with patient prognosis (P < 0.05). Multi-factor logistic regression analysis found that PCT, NLR, and APACHE II scores were independent risk factors for patient mortality within 28 days (P < 0.05). ROC curve analysis found that PCT and NLR both had an AUC area > 0.7 in predicting patient death within 28 days (P < 0.05).ConclusionInflammatory factors such as NLR, CRP, and PCT have important clinical applications in the assessment of the extent of disease and prognosis of patients with bloodstream infection and sepsis.

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Section: Discussionmentioning

confidence: 99%

Value of CRP, PCT, and NLR in Prediction of Severity and Prognosis of Patients With Bloodstream Infections and Sepsis

Liang

2022

Front. Surg.

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“…Maximum bactericidal antibiotic therapy seems more important in PS. In this connection, a recent retrospective study, restricting patient recruitment to community-acquired bacteraemia demonstrated a better effect by the addition of one single dose of aminoglycoside to the β-lactam treatment than most other comparative studies investigating the effect of this combination 32 .…”

Section: Discussionmentioning

confidence: 96%

Enhanced bacterial clearance in early secondary sepsis in a porcine intensive care model

Wilske

Skorup

Hanslin

et al. 2023

Sci Rep

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Early secondary sepsis (ESS), occurring after recent inflammatory activation is associated with a reduced inflammatory response. If this attenuation also is associated with decreased bacterial killing, the need for antibiotic efficacy might be greater than in primary sepsis (PS). This prospective, randomised interventional study compares bacterial killing in ESS and PS in a large animal intensive care sepsis model. 38 pigs were intravenously administered live Escherichia coli for 3 h. Before baseline ESS was pre-exposed to endotoxin 24 h, whereas PS was not. Bacterial growth was measured in organs immediately post-mortem, repeatedly during 6 h in blood in vivo and for blood intrinsic bactericidal capacity ex vivo. Splenic growth was lower in ESS animals, than in PS animals (3.31 ± 0.12, vs. 3.84 ± 0.14 log10 CFU/mL, mean ± SEM) (p < 0.01) with a similar trend in hepatic growth (p = NS). Blood bacterial count at 2 h correlated with splenic bacterial count in ESS (ESS: r = 0.71, p < 0.001) and to blood killing capacity in PS (PS: r = 0.69, p < 0.001). Attenuated inflammation in ESS is associated with enhanced antibacterial capacities in the spleen. In ESS blood bacterial count is related to splenic killing and in PS to blood bactericidal capacity. The results suggest no increased need for synergistic antibiotic combinations in ESS.

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“…Meanwhile, there is ongoing debate on the value of gentamicin as part of empirical combination therapy, usually combined with a broad-spectrum β-lactam antibiotic, especially for critically ill patients. Some observational studies found added clinical benefit of gentamicin for specific subpopulations [ 157 – 159 ] while others did not [ 150 , 160 , 161 ], and meta-analyses have shown conflicting conclusions [ 162 , 163 ]. An RCT is needed to evaluate the clinical value of gentamicin in empirical combination therapy [ 164 ], which is currently being performed [ 165 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Pharmacokinetics of Gentamicin in Various Patient Populations and Consequences for Optimal Dosing for Gram-Negative Infections: An Updated Review

et al. 2022

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Gentamicin is an aminoglycoside antibiotic with a small therapeutic window that is currently used primarily as part of shortterm empirical combination therapy. Gentamicin dosing schemes still need refinement, especially for subpopulations where pharmacokinetics can differ from pharmacokinetics in the general adult population: obese patients, critically ill patients, paediatric patients, neonates, elderly patients and patients on dialysis. This review summarizes the clinical pharmacokinetics of gentamicin in these patient populations and the consequences for optimal dosing of gentamicin for infections caused by Gram-negative bacteria, highlighting new insights from the last 10 years. In this period, several new population pharmacokinetic studies have focused on these subpopulations, providing insights into the typical values of the most relevant pharmacokinetic parameters, the variability of these parameters and possible explanations for this variability, although unexplained variability often remains high. Both dosing schemes and pharmacokinetic/pharmacodynamic (PK/PD) targets varied widely between these studies. A gentamicin starting dose of 7 mg/kg based on total body weight (or on adjusted body weight in obese patients) appears to be the optimal strategy for increasing the probability of target attainment (PTA) after the first administration for the most commonly used PK/PD targets in adults and children older than 1 month, including critically ill patients. However, evidence that increasing the PTA results in higher efficacy is lacking; no studies were identified that show a correlation between estimated or predicted PK/PD target attainment and clinical success. Although it is unclear if performing therapeutic drug monitoring (TDM) for optimization of the PTA is of clinical value, it is recommended in patients with highly variable pharmacokinetics, including patients from all subpopulations that are critically ill (such as elderly, children and neonates) and patients on intermittent haemodialysis. In addition, TDM for optimization of the dosing interval, targeting a trough concentration of at least < 2 mg/L but preferably < 0.5-1 mg/L, has proven to reduce nephrotoxicity and is therefore recommended in all patients receiving more than one dose of gentamicin. The usefulness of the daily area under the plasma concentration-time curve for predicting nephrotoxicity should be further investigated. Additionally, more research is needed on the optimal PK/PD targets for efficacy in the clinical situations in which gentamicin is currently used, that is, as monotherapy for urinary tract infections or as part of short-term combination therapy.

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Antibiotic treatment with one single dose of gentamicin at admittance in addition to a β-lactam antibiotic in the treatment of community-acquired bloodstream infection with sepsis

Cited by 14 publications

References 50 publications

Value of CRP, PCT, and NLR in Prediction of Severity and Prognosis of Patients With Bloodstream Infections and Sepsis

Value of CRP, PCT, and NLR in Prediction of Severity and Prognosis of Patients With Bloodstream Infections and Sepsis

Enhanced bacterial clearance in early secondary sepsis in a porcine intensive care model

Clinical Pharmacokinetics of Gentamicin in Various Patient Populations and Consequences for Optimal Dosing for Gram-Negative Infections: An Updated Review

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