Analysis of aminoglycosides in the treatment of gram-negative infections in surgical patients

被引:15
作者
Crabtree, TD [1 ]
Pelletier, SJ [1 ]
Gleason, TG [1 ]
Pruett, TL [1 ]
Sawyer, RG [1 ]
机构
[1] Univ Virginia, Hlth Sci Ctr, Dept Surg, Surg Infect Dis Lab, Charlottesville, VA 22906 USA
关键词
D O I
10.1001/archsurg.134.12.1293
中图分类号
R61 [外科手术学];
学科分类号
摘要
Hypothesis: Antibiotic regimens containing aminoglycosides result in a similar outcome compared with non-aminoglycoside regimens in the treatment of gramnegative infections in surgical patients. Design: An inception cohort study of hospitalized surgical patients from December 1, 1996, through September 30, 1998. Patients were observed from the time of diagnosis of infection to discharge. Setting: University hospital. Patients: Two hundred fifty-eight consecutive gramnegative infections occurring in general surgical and trauma patients and patients undergoing transplantation. Sixty-six patients received aminoglycosides as a component of their treatment regimen, whereas 192 received other agents. Results: Patients treated with aminoglycosides were younger (mean +/- SEM age, 48 +/- 2 vs 53 +/- 1 years; P = .04 by univariate analysis) and had a similar APACHE II (Acute Physiology and Chronic Health Evaluation II) score (mean +/- SEM, 17 +/- 1 vs 15 +/- 1; P = .10), yet had a significantly higher mortality vs patients treated with other agents (29% vs 14%; P = .02). A larger proportion of patients requiring hemodialysis were treated with aminoglycosides (33% vs 13%; P = .001). Although there was no difference in the sites of infection between groups, surgical patients with gram-negative pneumonia had a higher mortality when treated with aminoglycosides (37% vs 18%; P = .04), despite similar APACHE II scores (mean +/- SEM, 20 +/- 1 vs 18 +/- 1; P = .40). Conclusions: Despite a younger age and similar severity of illness, patients with gram-negative infections treated with aminoglycosides were associated with a higher mortality rate, although this may be related to selection bias in the use of aminoglycoside agents. The mortality rate associated with gram-negative pneumonia was also higher in patients treated with aminoglycosides, despite a similar severity of illness. Future randomized studies are necessary to reanalyze the role of aminoglycosides in treating surgical patients with gram-negative infections, particularly pneumonia.
引用
收藏
页码:1293 / 1298
页数:6
相关论文
共 19 条
[1]   ENDOBRONCHIAL PH - RELEVANCE TO AMINOGLYCOSIDE ACTIVITY IN GRAM-NEGATIVE BACILLARY PNEUMONIA [J].
BODEM, CR ;
LAMPTON, LM ;
MILLER, DP ;
TARKA, EF ;
EVERETT, ED .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1983, 127 (01) :39-41
[2]   NOSOCOMIAL PNEUMONIA - A MULTIVARIATE-ANALYSIS OF RISK AND PROGNOSIS [J].
CELIS, R ;
TORRES, A ;
GATELL, JM ;
ALMELA, M ;
RODRIGUEZROISIN, R ;
AGUSTIVIDAL, A .
CHEST, 1988, 93 (02) :318-324
[3]   PROSPECTIVE RANDOMIZED COMPARISON OF IMIPENEM MONOTHERAPY WITH IMIPENEM PLUS NETILMICIN FOR TREATMENT OF SEVERE INFECTIONS IN NONNEUTROPENIC PATIENTS [J].
COMETTA, A ;
BAUMGARTNER, JD ;
LEW, D ;
ZIMMERLI, W ;
PITTET, D ;
CHOPART, P ;
SCHAAD, U ;
HERTER, C ;
EGGIMANN, P ;
HUBER, O ;
RICOU, B ;
SUTER, P ;
AUCKENTHALER, R ;
CHIOLERO, R ;
BILLE, J ;
SCHEIDEGGER, C ;
FREI, R ;
GLAUSER, MP .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1994, 38 (06) :1309-1313
[4]   NOSOCOMIAL PNEUMONIA IN VENTILATED PATIENTS - A COHORT STUDY EVALUATING ATTRIBUTABLE MORTALITY AND HOSPITAL STAY [J].
FAGON, JY ;
CHASTRE, J ;
HANCE, AJ ;
MONTRAVERS, P ;
NOVARA, A ;
GIBERT, C .
AMERICAN JOURNAL OF MEDICINE, 1993, 94 (03) :281-288
[5]   NOSOCOMIAL PNEUMONIA IN PATIENTS RECEIVING CONTINUOUS MECHANICAL VENTILATION - PROSPECTIVE ANALYSIS OF 52 EPISODES WITH USE OF A PROTECTED SPECIMEN BRUSH AND QUANTITATIVE CULTURE TECHNIQUES [J].
FAGON, JY ;
CHASTRE, J ;
DOMART, Y ;
TROUILLET, JL ;
PIERRE, J ;
DARNE, C ;
GIBERT, C .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1989, 139 (04) :877-884
[6]  
GUIDOL F, 1986, J ANTIMICROB CHEMOTH, V17, P661
[7]   ANTIBIOTIC-THERAPY FOR PSEUDOMONAS-AERUGINOSA BACTEREMIA - OUTCOME CORRELATIONS IN A PROSPECTIVE-STUDY OF 200 PATIENTS [J].
HILF, M ;
YU, VL ;
SHARP, J ;
ZURAVLEFF, JJ ;
KORVICK, JA ;
MUDER, RR .
AMERICAN JOURNAL OF MEDICINE, 1989, 87 (05) :540-546
[8]   ANTIBIOTIC PENETRATION INTO LUNG TISSUES [J].
HONEYBOURNE, D .
THORAX, 1994, 49 (02) :104-106
[9]   PNEUMONIA CAUSED BY GRAM-NEGATIVE BACILLI [J].
KARNAD, A ;
ALVAREZ, S ;
BERK, SL .
AMERICAN JOURNAL OF MEDICINE, 1985, 79 (1A) :61-67
[10]   APACHE-II - A SEVERITY OF DISEASE CLASSIFICATION-SYSTEM [J].
KNAUS, WA ;
DRAPER, EA ;
WAGNER, DP ;
ZIMMERMAN, JE .
CRITICAL CARE MEDICINE, 1985, 13 (10) :818-829