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

Jason P Burnham,Scott T Micek,Marin H Kollef

doi:10.1371/journal.pone.0180247

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.

Highlights

Augmented renal clearance (ARC) is the term given to the phenomenon of accelerated glomerular filtration resulting in reduced systemic exposure to renally eliminated drugs
We previously described a cohort of patients with Enterobacteriaceae sepsis, severe sepsis, or septic shock that all received appropriate antibiotics within 12 hours of positive blood cultures and found that cirrhosis, African-American race, and presence of septic shock were risk factors for mortality [15]
Age, acute physiology and chronic health evaluation (APACHE) II and Charlson Comorbidity scores, and presence of CHF or African-American race were significantly different between the ARC and no ARC groups

Summary

Introduction

Augmented renal clearance (ARC) is the term given to the phenomenon of accelerated glomerular filtration resulting in reduced systemic exposure to renally eliminated drugs. The incidence of ARC varies by population studied, being more prevalent in persons with traumatic injuries, persons of younger age, males, and sepsis patients with lower acute physiology and chronic health evaluation (APACHE) II scores [1,2,3,4]. Augmented renal clearance in Enterobacteriaceae sepsis 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

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