Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: The clinical outcomes of Trimethoprim-sulfamethoxazole (TMP/SMX) doses used for treating
S. maltophilia in critically ill patients on renal replacement therapies (RRT) are not established.
Research Question or Hypothesis: We sought to assess the clinical outcomes of the suggested doses of TMP/SMX in patients with sepsis utilizing RRT.
Study Design: A retrospective observational investigation study conducted at our quaternary care hospital.
Methods: A retrospective chart review was performed on all critically ill adults with S. maltophilia infections who received RRT between May 2015 and January 2022. The primary endpoint was clinical cure, while the secondary endpoints were microbiologic cure, 30-day infection recurrence, and 30-day mortality
Results: Forty-five subjects met the inclusion criteria. The median age was 70 (63.50-77.0) years, 59.1% were males, and the median BMI was 25.7 (22 - 30.2) kg/m2. Clinical success and failure were reported in 18 (40 %) and in 27 (60%) cases respectively. Of the 35 subjects who had repeated cultures, 50% had microbiologic cure (clinical cure group) versus 8% in the clinical failure group. There was no significant difference in the 30-day reinfection rates in both groups, however, mortality was significantly higher in the clinical failure group 12 (44.4%) versus none in the clinical success group (p=0.001). The median daily dose of TMP/SMX on Continuous Veno-Venous Hemofiltration was 1064 (776-1380) in the clinical cure group versus 768 (540-1200) mg daily in the clinical failure one (p=0.03). While the median dose for those who received intermittent hemodialysis was 500 (320-928) mg versus 672 (440-1012) mg daily in both groups respectively, (p=0.372).
Conclusion: Although the S. maltophilia isolates were reported as susceptible, the outcomes of TMP/SMX conventional doses to treat bacteremia and pneumonia caused by this pathogen in critically ill patients utilizing RRT were associated with high rates of clinical and microbiologic failure as well as mortality. Larger studies are needed to confirm our findings
Presenting Author
Wasim Elnekidy PharmD, BCPS, BCACPCleveland Clinic Abu Dhabi
Authors
Emna Abidi PhD
Cleveland Clinic Abu Dhabi
Khaled Al Zaman MD
University of Sharjah
Diaa Alrahmany BSc Pharm
3- Pharmaceutical Care Department, Directorate General of Medical Supplies, Ministry of Health, Muscat 3110, Oman
Jihad Mallat MD
Cleveland Clinic Abu Dhabi
Islam Ghazi PharmD
Arnold and Marie Schwartz College of Pharmacy
Muriel Ghosn MD
Cleveland Clinic Abu Dhabi
Fadi Hijazi MD
Cleveland Clinic Abu Dhabi
Mohamad Mooty MD
Cleveland Clinic Abu Dhabi
Rania El Lababidi PharmD, BCPS (AQ-ID), AAHIVP
Cleveland Clinic Abu Dhabi