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6. Association between augmented renal clearance and clinical outcomes in patients receiving β-lactam antibiotic therapy by continuous or intermittent infusion: a nested cohort study of the BLING-II randomised, placebo-controlled, clinical trial

Author

Andrew A. Udy, Joel M. Dulhunty, Jason A. Roberts, Joshua S. Davis, Steven A.R. Webb, Rinaldo Bellomo, Charles Gomersall, Charudatt Shirwadkar, Glenn M. Eastwood, John Myburgh, David L. Paterson, Therese Starr, Sanjoy K. Paul, Jeffrey Lipman, Glenn Eastwood, Leah Peck, Helen Young, Catherine Boschert, Jason Fletcher, Julie Smith, Kiran Nand, Treena Sara, Amy Harney, Helen Rodgers, Frank Van Haren, Sally Clarke, David Durham, Catherine Hannan, Elisha Matheson, Kate Schwartz, Karen Thomas, Allison Bone, Claire Cattigan, Tania Elderkin, Tania Salerno, Robert Cameron, Katrina Ellis, Sheridan Hatter, Joshua Davis, Milind Sanap, Natalie Soar, Josette Wood, Karen Chan, Aaron Heffernan, Nai An Lai, Catherine Moss, Kate Sheehy, Maree Duroux, Megan Ratcliffe, Samantha Shone, Timothy Warhurst, Joel Dulhunty, Rachel Dunlop, David Paterson, Jason Roberts, Janine Stuart, Andrew Udy, David Cooper, Rick McAllister, Steve Webb, Andrew Cheng, Deborah Inskip, Jennene Miller, Serena Knowles, Claire Reynolds, Sam Rudham, Stuart Baker, Kristy Hepburn, Brigit Roberts, Paul Woods, Indranil Chatterjee, Judy Smith, Martin Cullen, Jing Kong, Vineet Nayyar, Christina Whitehead, Patricia Leung, Eileen Gilder, Lianne McCarthy, Shay McGuiness, Rachael Parke, Kirsten Benefield, Yan Chen, Colin McArthur, Lynette Newby, Seton Henderson, Jan Mehrtens, Sascha Noble, Lesley Chadwick, Ross Freebain, Chantal Hogan, Alex Kazemi, Laura Rust, Rima Song, Anna Tilsley, Anthony Williams, John Durning, Robert Frengley, Mary La Pine, Geoff McCracken, Swarna Baskar Sharma, Lynn Andrews, Richard Dinsdale, Anna Hunt, Sally Hurford, Diane Mackle, Jessica Ongley, Paul Young, Marin Kollef, John Turnidge, Sanjoy Paul, Udy, Andrew A, Dulhunty, Joel M, Roberts, Jason A, Davis, Joshua S, Turnidge, John, and Paul, Sanjoy K

Subjects
Adult, Male, Microbiology (medical), augmented renal clearance, medicine.medical_specialty, Metabolic Clearance Rate, medicine.medical_treatment, Renal function, beta-Lactams, Placebo, Cohort Studies, sepsis, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Sepsis, Internal medicine, medicine, Humans, critical illness, Pharmacology (medical), 030212 general & internal medicine, Renal replacement therapy, Infusions, Intravenous, Aged, Creatinine, business.industry, Organ dysfunction, Acute kidney injury, 030208 emergency & critical care medicine, Bacterial Infections, General Medicine, Middle Aged, medicine.disease, Anti-Bacterial Agents, Surgery, Clinical trial, Treatment Outcome, Infectious Diseases, chemistry, Female, medicine.symptom, business, ß-lactams, Cohort study
Abstract

Augmented renal clearance (ARC) is known to influence β-lactam antibiotic pharmacokinetics. This substudy of the BLING-II trial aimed to explore the association between ARC and patient outcomes in a large randomised clinical trial. BLING-II enrolled 432 participants with severe sepsis randomised to receive β-lactam therapy by continuous or intermittent infusion. An 8-h creatinine clearance (CLCr) measured on Day 1 was used to identify ARC, defined as CLCr ≥ 130 mL/min. Patients receiving any form of renal replacement therapy were excluded. Primary outcome was alive ICU-free days at Day 28. Secondary outcomes included 90-day mortality and clinical cure at 14 days following antibiotic cessation. A total of 254 patients were included, among which 45 (17.7%) manifested ARC [median (IQR) CLCr 165 (144–198) mL/min]. ARC patients were younger (P

Published
2017
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8. Special Considerations in the Management of Osteomyelitis Defects (Diabetes, the Ischemic or Dysvascular Bed, and Irradiation).

Author

Catherine Hannan

Subjects
*SPINE diseases, *ENDOCRINE diseases, *ENDOCRINE glands, *ENDOCRINE manifestations of general diseases, *HYPERADRENOCORTICISM
Abstract

Although osteomyelitis is a difficult problem, certain conditions make it even more difficult to address. Diabetes, peripheral vascular disease, and radiation are all comorbidities that interfere with wound healing and therefore make the treatment of osteomyelitis challenging. In this article, we discuss these conditions, their pathophysiology, and highlight the special considerations in treating osteomyelitis in patients with these comorbidities. [ABSTRACT FROM AUTHOR]

Published
2009
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