Samuel Aitken, PharmD, MPH, BCIDP
Clinical Pharmacist Specialist, Infectious Diseases
University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Patrick McDaneld, PharmD, BCIDP
Clinical Pharmacist Specialist, Infectious Diseases
University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Jeffrey Bruno, PharmD, BCCCP, BCNSP, FCCM
Clinical Pharmacist Specialist, Critical Care and Nutrition Support
University of Texas MD Anderson Cancer Care Center, United States
Disclosure information not submitted.
Title: Impact of Adjunctive Aminoglycosides in Hypotensive Septic Oncology Patients Receiving Beta-Lactams
Introduction: Aminoglycosides (AG) are often used in combination with beta-lactams (BL) to enhance the spectrum of activity in presumed gram-negative infections, mitigate risk of antibiotic resistance, and improve clinical outcomes. The benefit-risk profile of AG + BL combination therapy in the oncologic patient population is uncertain. This study aimed to assess the impact of adjunctive AG therapy upon time to resolution of hypotension in septic oncology patients receiving an anti-pseudomonal BL.
Methods: This single-center, retrospective cohort study evaluated adult patients with sepsis identified by ICD-10 codes (A41.9, R65.2, R65.21) who received a BL +AG (>1 dose of IV tobramycin, gentamicin, or amikacin) within 6 hours of onset of hypotension from 1/1/19-12/31/19. Hypotension was defined as MAP < 65 mmHg on two consecutive readings or once followed by vasopressor use. The primary outcome was time to resolution of hypotension within 7 days, defined as MAP >65 mmHg for >24 hours without vasopressors.
Results: Two hundred and thirty-two patients were included: AG + BL (n= 64), BL (n= 168). The AG + BL group had a higher proportion of hematologic malignancy (71.9% vs 42.3%) and culture-positive infection (68.8% vs 36%) compared to the BL group. After accounting for clinically relevant factors, time to resolution of hypotension was similar between groups in the total population (49.7 vs 41.9 hours: HR 0.99, CI 0.67-1.48) and in subgroups of patients admit to ICU at baseline (HR 1.06, CI 0.68-1.67) or required early vasopressor support (HR 0.92, CI 0.56-1.5). Patients in the AG + BL group experienced similar 14-day mortality compared with the BL group (29.7% vs 35.1%; p=0.434). After excluding those with acute kidney injury (AKI) at baseline, adjunctive AG therapy was not associated with an increased risk of AKI at 72 hours or 7 days.
Conclusions: The use of adjunctive AG therapy did not improve the time to resolution of hypotension in septic oncologic patients already receiving treatment with a BL, with similar findings in the subgroups of patients admitted to the ICU or who required early vasopressor support.