Impacto de dose de ataque de beta-lactâmicos em pacientes críticos com sepse

• Ano de defesa: 2019
• Autor(a) principal: Oliveira, Rafael Trindade De [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Unidades De Terapia Intensiva; Beta-Lactâmicos; Sepse; Estado Terminal
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7218841; https://repositorio.unifesp.br/handle/11600/59542

Objectives: To evaluate the clinical outcome of sepsis or septic shock patients submitted or not to a beta-lactams (BLs) loading dose protocol in the first twenty-four hours of treatment. Methodology: A quasi-experimental study was conducted in adult patients with sepsis or septic shock in a large teaching hospital in São Paulo, Brazil, comparing a group of patients that received a loading dose (LD) protocol of ceftriaxone (2g q12/12h), piperacillin-tazobactam (4,5g q4/4h) and meropenem (2g q8/8h) on the first 24 hours of treatment, analyzed prospectively, in the period from September 2016 to August 2017, with a group of patients that received standard dose (SD) of the same beta-lactams, analyzed retrospectively, matched by age, Charlson score and hospitalization period. In-hospital mortality and clinical success primary outcomes was analized, in addtion to hospitalization length, intensive care unit (ICU) length, vasoactive drug (VAD) length, mechanical ventilation (MV) length and evolution to renal replacement therapy (RRT), as secondary outcomes. Significant outcomes to the univariate analysis were subjected to multivariate analysis by logistic regression as dependent variables, thus establishing whether LD was a modifier of outcomes. Results: 150 patients were analyzed with sepsis/septic shock, 50 of LD group and 100 of SD group. Mean age was 57.8 years (± 18.71), 50% were male, 77% of clinical admission and average APACHE 2 score was 20.5 (± 7.7). In the univariate analysis, clinical failure (10/50 (20%) x 42/100 (42%), p = 0.0078) and in-hospital mortality (14/50 (28%) x 49/100 (49%), p = 0.01) were significantly lower in the LD group, as well as evolution to RRT (1/50 (2%) x 27/100 (27%), p = 0.0002). Hospitalization (p = 0.69), ICU (p = 0.65), VAD (p = 0.07) and MV (p = 0.07) lengths were not statistically significant. In the multivariate analysis, LD was a protective factor of in-hospital mortality (OR: 0.38, 95% CI: 0.16-0.90, p = 0.02) and clinical failure (OR: 0.37, 95% CI, (OR: 0.04, 95% CI: 0.005-0.43, p = 0.007), as well as the evolution to RRT (OR: 0,04; IC 95%: 0,005-0,43, p=0,007). Conclusion: We observed that beta-lactams loading doses improved mortality, clinical success and progression to renal replacement therapy in sepsis or septic shock patients in univariate analysis, and remained independently protective of these outcomes in the multivariate analysis.