Abstract
The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of their antimicrobial treatment: 80–100% = good, 20–79% = moderate, and 0–19% = poor. The association between antimicrobial adjustment and a composite of unfavourable outcomes [intensive care unit stay ≥72 h, duration of sepsis >3 days, length of stay ≥7 days or all-cause 30-day mortality] was assessed using logistic regression. Of 110 included episodes, the adjustment was rated good in 47 (43%) episodes, moderate in 31 (28%), and poor in 32 (29%). Older age, Pitt bacteremia score ≥2, sepsis on day 1, and infection site were independent risk factors for unfavourable outcomes. The level of appropriateness was not associated with unfavourable outcomes. The number of antimicrobials, consultation with an infectious disease specialist, blood urea nitrogen 7–10.9 mmol/L, and hemodialysis were significantly associated with adjusted antimicrobial dosing. While the severity of the infection had a substantial impact on the measured outcomes, we did not find an association between dosing optimization and better outcomes.
Highlights
In the last 40 years, the prevalence of obesity has doubled in more than 70 countries, accounting for over 2 million deaths worldwide [1]
We describe a retrospective cohort of adults with class III obesity hospitalized for Bloodstream infections (BSI), where we assessed factors associated with adjustment of antimicrobial dosing and compared clinical outcomes according to the appropriateness of antimicrobial dose adjustments
We retrospectively assessed the impact of the appropriateness of antimicrobial dosing in patients with severe obesity hospitalized for BSI
Summary
In the last 40 years, the prevalence of obesity has doubled in more than 70 countries, accounting for over 2 million deaths worldwide [1]. Aside from comorbidities such as type 2 diabetes, hypertension, and cardiovascular diseases, obesity is associated with a high risk of infections [2,3]. In patients with severe obesity and cellulitis, a low antimicrobial dose upon hospital discharge was associated with either recurrence, emergency room visit, rehospitalization, or 30-day attributable death (odds ratio [OR] 3.6 95% CI 1.4–9.4) [7]. In a cohort of critically ill patients with complicated intra-abdominal and skin and soft tissue infections, high doses of tigecycline resulted
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