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Master Thesis

Impact de l’augmentation de la clairance rénale de la créatinine sur la guérison des infections bactériennes en réanimation

Abstract : Augmented renal clearance (ARC) is associated with lower plasma concentrations of antibiotics. The aim of CLEAAR study was to assess the clinical course of patients with antimicrobial treatment for infection and ARC, defined as measured creatinine clearance = 130ml / min / 1.73m2. In this prospective bicentric study, patients hospitalized in intensive care unit (ICU) with sepsis requiring an antimicrobial therapy, not dialyzed, were included. Primary endpoint was failure of antimicrobial therapy defined as death related to sepsis, continuation of antimicrobial treatment >48 hours beyond the expected duration, modification of antimicrobial therapy other than de-escalation or reintroduction of antimicrobials within 72 hours after end of treatment. Sixty three patients were included, 21% had ARC. Patients with ARC were significantly younger (53years (48- 61.5) vs 67years (62.5-78), respectively, p<0.0001), had less often septic shock (15% vs 48%,OR 0,2 [0,04- 0,86],p=0,03), received less intravenous fluids in the first 24h (0.5L (0.09-1) versus 2L (1-4),p<0,001), had more days without vasopressors on D28 (28days (28-28) vs 27days (23-28)), and less aminoglycoside (8% vs. 42%, OR 0.11 [ -0.8],p=0.002). The ARC group did not encountered more antimicrobial treatment failure (31% vs 30%, OR 1[0.3-3.6],p=0.9) and had the same delta in extra-renal SOFA compared to the group without ARC (3(1.5- 4.5) vs 3(0-5.3),p=0.9). ARC is common in ICU, affects younger patients who present less often septic shock with no difference in antimicrobial treatment failure. These results are to be completed with a multivariate analysis once all the patients are included.
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Master Thesis
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Jean Bardon. Impact de l’augmentation de la clairance rénale de la créatinine sur la guérison des infections bactériennes en réanimation. Médecine humaine et pathologie. 2017. ⟨dumas-02475940⟩

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